Ask Dr. Marla: My son woke up with a really bad cough

By Dr. Marla Shapiro on May 22, 2012


My son woke up in the middle of the night and was coughing like a seal. What should I do if it happens again?


You are describing croup, and it can be caused by many different viruses and, on occasion, bacteria. According to the Canadian Lung Association, children under five are commonly affected because their airways are smaller than adults’ airways. As a result, they are more prone to swelling of the airways that leads to that classic barky cough. The cough is always worse at night. 
The most common viruses that cause croup include parainfluenza, influenza or flu virus, adenovirus and respiratory syncytial virus (known as RSV). Typically, croup has a seasonal appearance. It is most common in the winter and the early spring. 
Usually, the infection appears non-specific with runny nose and fever. However, with swelling of the throat and airways, a barky cough develops. I remember my own children getting croup with the classic cough that sounded as if there was a seal in the house! Other common symptoms include a wheezing noise when breathing and a hoarse and raspy voice.

How is croup diagnosed and treated?

It’s usually based on a physical examination. It is unusual for an X-ray to be ordered unless your doctor is concerned that there might be another underlying illness such as pneumonia. Most cases of croup can be treated at home by following these tips:

  • Stay calm. The cough gets worse with crying, so staying calm will help your child stay calm as well.
  • Keep your child upright. A cool air vaporizer can be helpful when placed in their room.
  • If your child has a fever that is causing discomfort, then you can give acetaminophen. Remember, cough syrups are not recommended.
  • Keep the air cool or moist. You can do that in a steamy bathroom or by taking your child outside into the cool night air. (Keep them warm when taking them outside.)

On occasion croup can be serious. Signs that merit medical attention include difficulty in breathing that is persistent,a bluish colour to the skin, drooling or dehydration. In some instances, these children require hospitalization, the use of a steroid medication and the use of an oxygen tent. Typically, viral croup goes away in three to seven days.

Originally published in ParentsCanada, May/June 2012

By Dr. Marla Shapiro| May 22, 2012

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