Croup is a disease that causes swelling and narrowing in a child's voice box (larynx), windpipe (trachea), and breathing (bronchial) tubes that lead to the lungs. A child infected with croup may at first seem to have a common upper respiratory infection (URI), such as a cold. The first symptoms of URI, such as runny nose and congestion, usually last about 1 or 2 days. Croup symptoms, such as a barking cough, usually follow and last 2 to 5 more days.

An episode, or attack, of croup often occurs at night, with symptoms improving during the day. Because the coughing can occur suddenly and sound severe, the attacks can frighten both you and your child. But the condition usually is less serious than it appears or sounds. Usually, the symptoms gradually become less severe each night.

Managing your child's attacks of croup can help prevent symptoms from becoming so severe that you need to visit a doctor in a clinic or emergency room.

A croup attack usually can be managed at home. To help manage your child's episode of croup:

• Keep calm. An episode of severe coughing and breathing difficulty from croup can be unsettling or frightening. But it is usually not as severe as it sounds. Staying calm will help reassure your child and may prevent symptoms from becoming worse.
• Use techniques that soothe and comfort your child. If your child becomes upset and anxious, croup symptoms may get worse. For example, crying can make breathing more difficult. Provide comfort by holding or rocking your child. You may also be able to distract your child by reading a book, working a puzzle, or watching television.
• Create moist air. If you have a humidifier, hold your child and let the vapor blow directly into his or her face. You can also go with your child into the bathroom, shut the door, and turn on all the hot water faucets to create a moist and steamy atmosphere. Let your child breathe in the moist air for several minutes.
• Take your child outside. Exposure to cool outdoor air often helps open a child's airways, reducing the coughing and breathing difficulty of a croup attack. Make sure your child is bundled up appropriately before going out.

If symptoms improve with these methods, put your child back in bed with the humidifier blowing nearby. Do not smoke, especially in the house. If the episode occurs during the middle of the night, it is a good idea to sleep in or near your child's room until morning.

It is important to keep your child well hydrated. Offer water, noncaffeinated drinks, flavored ice treats (such as Popsicles), or crushed ice drinks several times each hour.

Your child may have recurrent attacks throughout the night. As long as symptoms improve with these methods, even briefly, your child should gradually feel better and you likely will not need immediate medical care.

But if at any time your child has severe difficulty breathing, call 911 or other emergency services immediately.

If your child's symptoms do not improve after about 30 minutes, call or visit your doctor. If the episode is very severe or occurs in the middle of the night, consider taking your child to the emergency room.