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Many parents will have the experience of your child waking up suddenly at night, coughing strangely, and may have difficulty breathing.

This is what is called acute laryngitis.

In many foreign languages, it is rendered with the sound-made term croup, which accurately conveys the sudden cough with a strange tone.

Acute laryngitis is a viral infection that occurs in infancy and preschool age.

There is inflammation in the larynx, mostly in the area below the glottis (vocal cords) which, due to swelling of the wall, narrows the airway. It manifests itself with hoarseness, a barking cough (“groaning”), noisy breathing (“sigh”) and sometimes respiratory distress.

Symptoms occur suddenly, almost always at night.

Usually preceded by hours to 1-2 days of mild upper respiratory symptoms and perhaps a low-grade fever. In some children, the episodes recur and parents recognize them easily.

Diagnosis is almost always simple. It is based on the symptoms and does not require blood tests or X-rays. Not even auscultation with a stethoscope. The least possible manipulations should be performed and the child should remain calm, without feeling threatened.

For the correct diagnosis, a distinction needs to be made between stridor and wheezing. Both are types of noisy breathing, the first originating from the upper respiratory tract (e.g. laryngitis, acute allergic reaction), the second from the lower (e.g. asthma, bronchiolitis).

Also, importance is given to the duration and tone of the cough. It can be acute (hours, days) or chronic (weeks). It can be dry (e.g. bronchitis), wet, indicative of the presence of bronchial secretions (e.g. chronic bronchitis) or rumbling, indicative of soft walls of the trachea and bronchi.

Depending on the intensity of the symptoms, laryngitis is classified as mild, moderate and severe. Mild is characterized when, in addition to the fibrous cough, hoarseness occurs occasionally, while moderate, when hoarseness is constantly present along with anxiety and irritability. It is considered severe when respiratory distress and fatigue or drowsiness coexist.

Most often, acute laryngitis in children is short-lived and self-healing. When it is mild, it can be treated at home. The child remains calm, without becoming agitated, without the panic on the faces of his parents, but with a behavior that inspires security. Many times exposure to cold air at the window or on the veranda helps.

In moderate or severe levels of severity, immediate assessment by a pediatrician is necessary. The diagnosis should be confirmed and for closer monitoring. Oral dexamethasone or inhaled corticosteroids (budesonide) with a nebulizer is administered.

In moderate and severe acute laryngitis, for the immediate treatment of edema and subglottic stenosis, additional nebulized adrenaline is required, which is administered in a hospital environment.

In severe cases, admission is necessary, as hospitalization in an Intensive Care Unit may be required.

Almost always, the course is smooth. Although the sudden onset and strange cough are frightening, parents should not worry. They should consult their doctor and calm our suffering little patients.

With proper care and treatment, the episode is soon overcome.