Croup, otherwise known as laryngotracheobronchitis, meaning inflammation of the larynx, trachea, and bronchitis, is one of the most common occurrences in children between the ages of six months and three years old. The condition is thought to be an inflammatory reaction to any number of common viral infections.
Croup usually begins with a runny nose, and a day or so later, the child develops a tight barking cough that closely resembles the bark of a seal. The cough usually comes in frequent paroxysms or waves, and then the child is relatively quiet in the interim periods.
The cough is tight, not wet, but also not wheezy as occurs with asthma. The tightness occurs because the larynx or windpipe is narrowed; therefore the child “pushes” hard to expel the air. Hence the bark and tight sound.
The First Night is the Worst
Generally, the first night is the worst, the second night is a little better and the third night better still. In the usual scenario, the child is relatively unaffected during the day, doing all their usual activities.
In the typical croup case, the child has minimal or no fever, no congestion in the lungs and no ear pain.
The main thing to consider is whether the cough comes from a much different illness called epiglottitis or infection of the epiglottis. This is a dramatic bacterial infection that is very rare.
I have seen one case in my entire career while working as an ER doctor. With epiglottitis, the child has a barking cough as with croup, but he is also very sick, drooling and can’t swallow anything. The child is short of breath and has a look of panic or doom on his face.
With epiglottitis, emergency care is essential including whatever tests and interventions are needed for that particular case. This is truly a life-threatening condition, albeit a very rare occurrence.
Traditional Croup Treatment Compared with Today
Interestingly, in my thirty-year career, I have seen a most definite shift in how physicians tend to treat croup.
In my first five or ten years as a physician, while practicing in small-town New Hampshire with mostly young families as patients, I saw hundreds of cases of croup each winter. I don’t remember doing a single throat x-ray (to rule out epiglottitis), and I never sent a single patient to the ER.
We generally had a ride-it-out attitude that is so different from the more aggressive treatment typically favored by today’s doctors and experienced by most parents of children with croup. I explained the life history of croup to the parents and gave them my four main interventions listed below. With this treatment, I had not a single bad outcome in all those years with all those children.
Now it seems as though many if not most children get an x-ray, blood test, and treatment with one dose of steroids and adrenaline. Again, besides the rare time when you can’t be sure you are not dealing with epiglottitis, there is no need for these things.
Easy Steps to Prevent a Trip to the ER
Here is the simple treatment I have used all these years with so much success. Following it resulted in literally no trips to the emergency room!
- The parents need to remain calm and relaxed. The sound of a croupy cough is disconcerting enough to any child! Any additional tension and anxiety from the parents just escalate the situation.
- It is important to get liberal fresh air into the child’s room by opening the window. Just a crack if the weather is cold, but fresh air is necessary. At the same time, keep the child warm, even a bit on the sweaty side, and give him/her frequent sips of warm tea (such as chamomile) and traditional bone broth.
- For medicines give one-half teaspoon of high-vitamin cod liver oil per day, as the vitamin A content has been shown to help all viral infections. Give the homeopathic combination spongia/bryonia, 3 drops every hour while the child is awake. This remedy often dramatically cuts the severity of the croup. Then give a natural form of vitamin C or liposomal vitamin C about 250 mg every two hours while awake. Continue these medicines until the whole illness is resolved.
- For bad episodes, particularly on the first night, go into the bathroom with the child, close the door, stopper the tub and let the hottest shower run until the room is steamy. Let the child breathe in the steam air for five to ten minutes for bad croup episodes. The alternative is to simply take the child (dressed up of course) briefly out into the cold night air. For some reason, this often dramatically breaks an acute episode. If the weather outside is warm, open the freezer door and let the child breathe in the cold air. Occasionally parents alternate these two treatments with good effect.
With these simple interventions and the usual close observation of your child along with rest and nourishment, the three days of managing croup symptoms naturally should pass with no aggressive treatments necessary. Your child will soon be up and about, with no adverse consequences.
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Keep in mind, however, that sometimes medical care is necessary. I used the method of steaming the bathroom with many of my children. (I have 10.) It worked fine. But for my youngest, he came into our bedroom one night barely able to breathe. We rushed him to the emergency where they gave him a breathing treatment and steroid asap. It was scary driving the short distance to the hospital, he could barely breathe.
I am just getting over bronchitis that grew from a croup-like virus. To top it off I’m allergic to several different classes of antibiotics! So this info is going to come in really handy.
The last time my son croup it was really bad, it didn’t hardly clear up during the first day, I was so worried that it would be terrible that night! We decided to put him to bed in the recliner in our room with the humidifier and he didn’t cough once all night! He just improved from there, I think laying down lets it all settle in. That first day I wanted to try giving him mullein tea but I couldn’t find any, I have some to try next time though.
We always did vitamin C, zinc/echinacea lozenges, and plug in vaporizer- humidifier in the room at night. It helps the kids rest and sleep through the night. There’s no substitute for rest.
I’ve dealt with croup at least a dozen times with our nine children. Ana, I have had similar experiences with some of my kids. Some respond well to alternating the steam/cold air. Then, we always set up a humidifier in their room which often prevents further episodes on subsequent evenings. However, I have had a few who were like Ana’s with the gasping breath and the low ox sats. I wonder if it is related to a weakness toward asthma? I have asthma, and several of my kids had have had a rare asthmatic episode here or there? I just had a 14yo take an emergency ride in an ambulance for what turned out to be a throat infection (with inflammation) and croup. At the time I called the ambulance, I thought she was having an allergic reaction to the medication she had started that day for her illness. She was clutching her throat and having trouble breathing. As a rule, I’m pretty unflappable with croup, but yes, I think there are times it requires a more aggressive treatment like in the case of your son.
my kid had it once this winter. I used Homeopathy. diff ones then mentioned. They worked great. croup was 3 days! last winter we were 3 weeks with it. Also did steam in bathroom. sense cold air and running around in it gave her it We stayed inside. but yah cold air always makes your nose run so make sense. last year she would be on the mends and we went outside to car and she would relapse. another reason we stayed in till she was all good. all depends on kid and what sets them off on the croup train. good article!!
My toddler has had two episodies of croup, and both ended up at ER with steroids orally and the last time inhalled too, as his oxygen saturation was very low. I’m all for natural medicine, so we went to the ER as the last resource. The croup wasn’t as scary as the fact that he coudn’t breath. He seemed an asmathic suffocating, with very scary sounding breathing. He seemed in danger for it. I did the steam thing in the bathroom several times, and it seemed to work, after a while the child breathed somewhat better, but then I put him to sleep, and after a while there was the same thing again, he coudn’t breath well. I discard the epiglottitis, because in none of the episodies antibiotics were needed. I’d love to hear the doctor opinion in this particular case, with such a shortness of breathing, as I always see information on how to treat croup naturally focusing on the cough, not on the shortness of breath. Is there anything I could do to avoid an ER trip if it occurs again? How can we tell when the child is in real danger? Thanks in advance.
My toddler had croup from time to time and the thing that works wonders is to leave the window open a crack to let in the cold night air. Bundle up to keep their body warm. It’s amazing how well it works. #2 suggestion
Have you ever heard of nebulizing colloidal silver? My son has had croup almost a dozen times with one serious trip to the ER. I do do all of the suggested above but with our last episode we used colloidal silver and it seemed to help A LOT. Just wondering if others have tried it. Ps, my son is 3 now and his croup episodes started at 9 months…
take them for a drive in the car with a warm jacket on, and roll the window down to have them breath cool air – we give popsicles to cool down too. Both help. Nice to see Dr. Cowan’s article here.
Over fifteen years ago, my conventional pediatrician recommended #4 when my son had the croup. we alternated between steam and cold night air. He was fine and I knew what to do when he had it a second time. We used the same method a few years ago when our daughter got croup and never went to the doctor.