Croup is a narrowing of the air passage through the larynx, the voice box in the neck where the vocal cords are located. If the narrowing is severe, the air cannot reach the lungs, and the child begins to choke. The narrowing is caused by spasm and swelling of the larynx. These may be the result of certain bacterial infections or very severe allergy, but they are most often caused by a virus, sometimes by bacteria. Fortunately, the disease is rarely fatal. But it can be terribly frightening to both the child and the parent. It usually comes in spasms. The attack is generally precipitated at night. The mild fever and the apparent healthy look of the child between the spasms—and the fact that the child has been immunized against diphtheria—usually make it certain that the illness is croup, not the onset of diphtheria of the larynx. However, always notify the doctor when the child develops a hoarse, croupy voice or cough, or seems to be having spasms of difficult breathing.
Occasionally, a severe attack of croup may represent an emergency before the doctor can be summoned. The spasm can be relieved by placing the child in a place where there is cool moist air. Hospitals are equipped with special apparatus with which to provide this cool moist air, but at home, warm, moist air can be an adequate substitute. A croup tent can be improvised by boiling water in a kettle or pan on an electric hot plate under a blanket which is placed over the child and the parent. The parent or other adult must always sit with the child during the treatment. The reason for this is important to know: more children have been burned to death during treatment for croup than have died of the disease itself! Keep the steam going until the spasm has been relaxed. The important thing is to allow the child to rest. Plenty of clear fluids are helpful.
If a croup tent cannot be improvised, or you cannot get a good water vaporizer rushed over from your druggist, fill the bathtub with steaming hot water, or turn the shower bath on and keep the hot water running. Keep the window and door closed so that the bathroom becomes saturated with moist air. This technique usually is as good as the above methods. Sit with the child, never taking a chance for a second that the child can be trusted not to fall into the scalding hot water. Even an older child who starts a paroxysm of croup may become so breathless and frightened that he doesn't know what he is doing.
The attacks of croup tend to repeat themselves, usually in two or three successive nights. Ask your doctor what to do to prevent further attacks. He may leave medicine that will help shorten another attack, if the spasm cannot be prevented.
Note: If an attack of croup doesn't respond to the above measures in twenty minutes, or if high fever is present, the situation is a serious emergency. If you cannot reach your doctor, rush the child to the hospital.
