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Rachel McGuffey, M.D., Lexington Clinic Pediatrics

During the fall, as the temperature changes, we see a large number of kids come in with croup.  One hallmark of croup is the barky seal or dog-like cough that hits in the middle of the night.

Croup is a viral infection that is typically caused by parainfluenza. It can be caused by other viruses, including influenza. The child usually develops a little runny nose, can develop fever, and then in the middle of the night will develop the barky cough. The cough generally is better during the day and will start to flare again when the sun goes down.  

Croup causes inflammation of the upper airway. A child with croup may develop stridor which is a loud inspiratory sound. This will be followed by the barky cough. The stridor will worsen if the child is upset.  

If your child develops croup, you should try to keep the child as calm as possible. Cool air helps with the inflammation. You can take your child into the cool night air, run a cool mist humidifier or open your freezer door and let the cool air run across your child’s face. If your child has blueness of the lips or cannot stop coughing, you should have the child seen immediately.  

Since croup is a viral illness, antibiotics are not recommended unless an underlying bacterial infection, such as ear infection or bronchitis, is diagnosed. In severe cases of croup, your child may receive a nebulization of racemic epinephrine, which will quickly resolve the symptoms. This is usually used for children in the emergency department or a child hospitalized with croup since rebound from the medication can occur. For cases that do not need hospitalization, doses of oral steroids or intramuscular steroids will help the inflammation and resolve the symptoms more quickly.  

Having your child awaken with a croupy cough in the middle of the night can be scary.  Remember to keep your child calm and try cool air. If symptoms are not improving or your child has blueness of the lips or body, seek medical attention immediately. If your child’s symptoms improve, you can wait until morning and consult with your pediatrician for further treatment.