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Ask Dr. Sears: Treating Croup

Q. How long does croup usually last in a 3-month-old? We are so concerned about pneumonia. What can I do other than breastfeeding and praying?

A. Croup is a viral infection that causes swelling of the vocal cords and adjacent breathing passages. Its most recognizable symptom is a "seal-bark" cough, which is caused by air passing forcefully through swollen and narrowed vocal cords. Because this swelling can obstruct breathing, it's important for you to recognize when croup is serious and when it is just a cold.

Signs of Serious Croup

Watch out for these signs that baby's breathing passages is partially obstructed:

  •  Your baby seems restless and has an anxious, even panicky look on her face.
  • The front of your baby's neck caves in when she takes a breath. This is called "in-drawing."
  • Breathing, especially inhaling, is getting increasingly noisy, a symptom known as "stridor."
  • And the most serious sign is that your baby can't cry due to lack of breath.

Any increase of in-drawing or stridor, and especially any diminishing of the sound of crying is a sign to take your baby to the emergency room immediately.

Treating Croup at Home. 

If your baby's cough sounds croupy, but she is smiling, sleeping and feeding normally—in other words, the croup really isn't bothering her much—it's likely that this is a non-serious type of croup. The good news is that parents can usually prevent minor croup from becoming serious with these home remedies:

  • Relax your baby. Dr. Bill's croup rule: If your baby is relaxed, her airway is also likely to relax. Pull out all the stops to comfort your baby. Sleep, in particular, is one of the best croup remedies. If you can help your baby fall asleep, the in-drawing and stridor usually decrease.
  • "Steam clean" your baby's airways. Misty humidity helps croup. Take your baby in the bathroom, turn on the hot water in the shower, and sit with your baby and sing songs. This will keep inflamed vocal cords from drying out and also thin the mucus so that it doesn't plug the airways. I have also noticed that croup often improves during a car ride, with the windows open.
  • Hose baby's nose. 3-month-old babies prefer to breathe through their noses. Since a plugged nose often accompanies croup, you want to clear the nasal passages. Spritz some saltwater drops (available over-the-counter as saline nasal spray) into your baby's nose. Then suck out her nose using a nasal aspirator.
  • Breastfeed your baby. As you mentioned, breastfeeding is one of the best natural relaxants for babies with breathing difficulties. I once met a mother and her 1-year-old with severe croup at the emergency room. Even after treatment of high humidity in a mist tent, the baby's breathing was only getting more labored. Unless her baby totally relaxed, I told the mother, I would have to notify the surgeon to be ready to do a tracheotomy. (A procedure that's rarely needed, except in the most severe cases.) The mother knew what to do: She put her breast through an opening in the mist tent, sang some soothing songs, and stroked her baby with a therapeutic touch that only a mother can give. The baby immediately relaxed and breathed easier, as did the surgeon and I.
  • Nurse more frequently. Labored breathing uses up a lot of extra energy so that baby needs more nutrients—another reason why nursing helps fight croup. The extra fluids from your breast milk also keeps the secretions in the breathing passages thin so that they can more easily be coughed out. Also, baby is less likely to get tired if you nurse your baby more frequently but for shorter amounts of time at each feeding.