Have you ever woken up in the middle of the night, certain that your child has been replaced by a barking seal? If so, you’ve experienced croup. You can hear an example at http://mommyhood101.com/baby/audio/croup.html

Croup, otherwise known as laryngotracheobronchitis, is inflammation around the vocal cords. In its mildest form, the child experiences a barky cough; in its worst form, the swelling closes off the airway and requires a breathing tube until the inflammation is resolved.

What causes it? It can be caused by a number of viruses, including RSV and influenza, but the vast majority are caused by parainfluenza virus. There are 4 types or strains of paraflu, and parainfluenza 1 is responsible for most major outbreaks. For reasons that are not entirely clear, the outbreaks occur in the fall of odd numbered years. Hence this year is the year of the Barking Seal.

Most children start with a runny nose and the cough becomes more barky on the second and third days of illness. The croupy sound is usually worse late at night. Again, the reason is not clear; some people say it’s because the body’s natural steroid levels are lowest in the early morning, others say it’s because gravity can’t help drain the swelling when the child is lying down,

If your child develops a barky cough, give him or her a dose of ibuprofen to help reduce the inflammation. Sometimes taking the child out in the cold air helps. Despite the numerous references in parenting magazines and even old medical textbooks, there is no proof that mist helps croup symptoms. (I had an attending in residency that went nuts every time the nurses went running for a humidifier for a kid with croup and we residents would have to listen to his lecture *again* about the endless studies showing it doesn’t help.) In kids with lots of nasal congestion, it can help clear their nose.

If your child starts making high-pitched noises while breathing (called stridor) or seems to be having trouble breathing, he or she needs to be seen by a physician right away. Unfortunately, since this is usually in the middle of the night, it often means a visit to the emergency room. Sorry, but that’s the way it goes. Depending on the level of distress, your child will receive a breathing treatment, steroids or both.

If it is just a barky cough, bring your child to the office in the morning to determine if he or she needs a dose of steroids to prevent worsening symptoms.

It is fairly contagious; 50% of kids of evidence of having parainfluenza infection by age 12 months. Kids can shed the virus from their nose for 1 week before and up to 2 weeks after the barking cough. Translation: wash your hands, wash your hands, wash your hands!