When your toddler wakes up with a hoarse and raspy voice, or with almost no voice at all, your doctor might say he has croup, the name for laryngitis in a child younger than age 5. A viral infection most often causes croup, an infection of the laynx and vocal cords. Because children with croup have noisy breathing and a barking cough that often worsens at night, croup is a common cause for late-night emergency room visits. Inflammation of the epiglottis, which keeps food from entering your lungs, is another type of laryngitis in children.
Viral infections such as parainfluenza -- the cause of between 50 percent and 75 percent of all cases of croup, according to Dr. Roger Zoorob, professor of family and community medicine at Meharry Medical College in Nashville, Tenn. -- that settle in the larynx and the vocal cords lead to swelling and inflammation. Because a toddler's throat has a small opening, any swelling that further reduces the size of the opening affects the way his voice sounds. The incidence of croup peaks in the second year of life, Zoorob explains. Vaccination with Haemophilus influenzae Type b prevents most cases of epiglottitis, a potentially life-threatening form of laryngitis in toddlers.
In addition to having a raspy, hoarse voice, a toddler with croup often has a harsh, barking coughing that sounds like a barking seal. With either croup or severe epiglottitis, your child might run a fever, be anxious or restless, struggle to catch his breath, have very noisy breath sounds or breathe rapidly. You might notice retractions, a tugging of the skin between his ribs or in his neck as he breathes. If you watch his nostrils, you might notice that they flare out with every breath, which is an attempt to get more air into the lungs. As breathing becomes more difficult, he might become extremely fatigued or lethargic.
The time-honored treatment for croup is to sit in a small room such as a bathroom and fill it with steam. Closing the door and running hot water into the tub normally fills the room quickly. The steam, theoretically, reduces the swelling and allows your toddler to breathe more easily, according to the American Academy of Pediatrics. In practice, however, this has not proven to reduce croup severity or the need for additional medical care, according to Zoorob and the hot water brings the risks of burns if your toddler touches it. Instead, run a cool-mist humidifier during the night if your child has croup or take him outside briefly if the air outside is cool. Medications such as steroids reduce the inflammation and swelling, making it easier for your toddler to breathe.
When to Seek Help
Croup can turn into a medical emergency if the airway becomes so swollen that air can't pass through to the lungs. This happens most frequently when your child has epiglottitis. Sleep in the same room with your toddler, if possible, so you can easily hear if his breathing becomes faster or if he sounds as though he's having more difficulty getting air into his lungs. Difficulty breathing needs immediate medical treatment; call for emergency help if he's working hard to breathe or if his skin is turning blue.