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True croup is an infection of the airway just above the epiglottis (that fold of tissue that covers the airway when you swallow food or drink). The full term is "laryngotracheobronchitis" since it can afflict all 3 of those areas. The true croup is caused by the virus parainfluenza, and is most prevalent in the winter months. The main age of the child is 3 months to 5 years, and there appears to be a strong family history. It usually starts out as a cold, but then a characteristic "barking" cough appears along with high fever and noisy breathing ("stridor"). Typically, there are other family members ill with colds and coughs. The child is uncomfortable, has difficulty breathing and the symptoms typically worsen at night. Treatment at home consists of humidity and benadryl (diphenhydramine). If this doesn't relieve the symptoms, hospitalization may be necessary to administer oxygen and aerosolized epinephrine. The steroid decadron also relieves the symptoms. "Pseudocroup" is the term given when the child has the barking cough and noisy breathing but without the high fever. Usually there are other family members with colds. This illness is due to different viruses. The child with pseudocroup may also require hospitalization. "Spasmodic croup" is an allergic or viral condition in which a child has the runny nose and barking cough but no signs of infection. Usually no other family member is sick. This occurs mostly at night and there is a history of repeated occurrences in the same child. Finally, "epiglottitis" is an infection of the epiglottis caused by the bacterium H. influenza b (HIB). This was very common in children 6 months to 6 years of age up until recently, as the HIB vaccine has pretty much wiped it out. I used to see several cases of this a year, but I haven't seen a single case in 12 years.....another successful vaccine story!! Children with this infection typically are well before they suddenly run a high fever and develop a barking cough, inability to talk, drooling (because it hurts too much to swallow their own saliva) and appear extremely ill. Usually no other family members are ill. This requires immediate hospitalization, intubation to protect the airway, and intravenous antibiotics.