Croup Versus Wheezing — What is That Horrible Sound?

A sick child who suddenly awakens in the middle of the night making a terrible sound and having trouble breathing can be terrifying. The two conditions most likely to produce this situation are croup and wheezing.

Because the immediate home treatment of croup is quite different from that of wheezing, it is helpful to try to make the distinction. Using some audio files lets highlight the differences in the sounds:

Croup is caused by inflammation of the windpipe, most commonly associated with major winter viruses like parainfluenza. Children have relatively small diameter windpipes, so very little swelling of the mucous lining is required to produce the classic features. Breathing in makes the windpipe narrower, so the sound is generally louder; breathing out enlarges the windpipe, so the sound tends to lessen or disappear.

Notice on this audio clip first the barky cough, and then, the “stridor” or squeaking sound as the child breathes in:

Wheezing, which is most commonly associated with asthma, or in young infants, bronchiolitis, is caused by the collapse of the bronchi (medium airways) or bronchioles (smallest airways) within the chest, that is, below the neck. The effects of breathing in and out are just the opposite of those with croup. When a child breathes in, the bronchi or bronchioles get bigger, so it’s easier for the air to move. But when the child breathes out, the airway narrows, producing the wheezing sound, and resulting in more time needed to breathe out compared to breathing in.

On this audio clip notice first the characteristic wheezing sound. Then, try to focus on how long it takes the child to breathe out:

Both sounds warrant a call to the Advice Nurse to help decide if the child needs to sent to an Emergency Room, or during daytime, to our office for evaluation and treatment, especially if your child seems to be having trouble breathing. But if the child seems comfortable, and the sound is barky, then steam from the shower or cool outdoor air could be tried first before you call.

If your child is wheezing for the first time ever, you should certainly call, and will very likely be referred quickly on to our clinic or the Emergency room. If your child has had wheezing before and you have albuterol on hand as either a metered dose inhaler with a spacer (such as an Aerochamber) or a nebulizer, then you could give your child a treatment. If she responds, you should still call in during clinic hours for further directions. If she doesn’t, then call the Advice Nurse for further instructions.