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So you hear a barking cough from your child's room at 1:00 am. What is it, and what can you do to help your child?

That barking cough you hear is called croup, a sound that can cause a lot of concern and rightfully so.

So what is croup? Croup is actually a viral infection of the vocal cords and the trachea, which is the windpipe. It causes a tight, low pitched, barking cough. It actually sounds like your child is a seal with how they're barking. They can also have a hoarse voice leading up to it.

Sometimes they have a vibrating, raspy sound when they breathe in called stridor. Stridor is a scary sound, because they're sitting there and they're coughing, and then all of a sudden when they take a big breath, you hear [makes sounds] and that's cause for alarm.

With severe croup, breathing actually becomes difficult. Croup is usually part of a cold, and there's a bunch of viruses going around right now, all of which can cause the croupy cough.

When your child has croup, the hoarseness and the bark are actually caused by the opening of the vocal cords becoming more narrow. It's like the space between the vocal cords went from being that of the diameter of a straw to that of being the diameter of a coffee stirrer. It's really hard to push air through something that narrow, and that's when you hear the bark when they're trying to take a deep breath in and cough that air out very forcefully.

Croup usually lasts for a couple of days, and it generally gets worse at night. We do hear it during the daytime, but it's almost always at night, and for some reason it likes the times between 11:00 pm and 1:00 am.

It can go back and forth from being mild to severe, but the worst symptoms are seen in kids under the age of 3, and usually we don't see it after the age of 8 when your child's airway is bigger and can allow for more swelling before the airway gets too constricted.

So how can you treat stridor? One of the best things to do when you're at home is get the shower all steamed up and get your child in the bathroom, because warm, moist air seems to work best to relax the vocal cords and break the stridor. A humidifier, not a hot vaporizer, but a cool mist humidifier also will help with getting the swelling down. Cold air also helps relieve stridor. If it's cold outside, take your child outdoors. If it's not cold outside, you can actually hold your child in front of an open freezer door and have them take a few deep breaths in.

The one thing you want to do is try and keep your child calm, because most children settle down with these treatments. But if they don't and they get more anxious, they'll have more stridor. If they actually start having their airway close off enough, they will start to turn blue. They may pass out or stop breathing and definitely call 911 at that time.

If your child continues to have stridor, but it's not completely blocking their airway, take them to the closest children's emergency room. Your child may receive a dose of a steroid called dexamethasone, which helps shrink the swelling in your child's airways. In severe cases, they may receive a breathing treatment of a medicine called racemic epinephrine that will actually help really quickly shrink the airway swelling down. Your child would then be admitted to the hospital for close observation overnight to make sure that the swelling doesn't come back.

So at home if your child is not too severe and you need to have them just managed at home, things you can do include:

• that humidifier, because dry air makes a cough worse, so the humidifier will help;
• warm fluids for the coughing spasms.

Coughing spasms are often due to sticky mucus caught in the vocal cords, so the warm fluids may actually help relax the vocal cords and loosen up that mucus. Cough medicines are much less helpful than the mist or the warm fluids for croup, and children over 6 years old can be given cough drops for the cough, but children under the age of 4 should not be given any cough medications. It's not really safe. Children over 12 months old can be given some honey on a spoon to help, but never give honey to babies.

If your child still has the croup, you can take them to your local pediatrician, and they can also be prescribed the steroid treatments that I mentioned when I talked about the emergency rooms. If your child is stable enough to be treated at home, the dexamethasone can be prescribed, and that medicine takes care of the barkiness of the croup cough, but the virus still needs to run its course, and the cough itself, not the barky part, but the cough that goes with the virus can last for up to three weeks.

The viruses that cause croup are actually quite contagious until the fever is gone or during the first three days of illness. Your child can return to school once they feel better.

So remember if your child has that barky seal cough in the middle of the night, figure out:

• Can I manage this at home?
• Do I need to take them to the emergency room?
• Can they be seen in the doctor's office?

And most of all stay calm because that will help your child stay calm as well.

updated: January 2, 2023
originally published: January 12, 2015