Croup causes a cough that sounds like a bark of a seal or a dog. Children with croup often have some trouble breathing because the airway is narrowed in this disease and breathing produces a sound (stridor) as air passes back and forth. Fortunately, many children (and adults) who get croup have very mild symptoms, and the disease resembles more of a bad cold with congestion. Croup is usually diagnosed simply by the doctor listening for the barking cough and stridor. However, sometimes other conditions can lead to similar symptoms, and occasionally a physician will order an X-ray of the child's neck to determine airway narrowing.
What will they do for you in the ER? As they evaluate your child, they should encourage you to hold him in your lap, remember to keep him calm. They might measure his blood oxygen level, with an oximeter or “pulse-ox.” This uses a small light source that is wrapped around a finger or toe and helps determine how your child is breathing. They might have you blow cool mist in front of your child’s face. If your child’s croup is severe enough (which is why you’re in the ER), they may give him vaporized Epinephrine to breathe with the cool mist. This works quickly to open the airways. Depending on the situation, the ER physician may recommend a short course of steroids. Don’t worry; this is not the “body-building” type of steroids. These will help keep the air passages open over the next few hours to days. Your child will only be on the steroids for a few days, there are no side effects to worry about when used for this short time. The first dose often needs to be given as an injection, since the child with severe breathing difficulty is in no mood to take an oral medication, or he may throw it up.