Croup

What Is Croup?

It's the middle of the night and a loud barking cough from your child's room suddenly awakens you. Although the loudness and harshness of your child's cough may frighten both of you, it's important to stay calm. This peculiar cough, often described as sounding like the barking of a seal, usually isn't serious and often can be treated at home. It's caused by a condition called croup.

Croup is an inflammation of the voice box (larynx) and the airway just beneath it. Your child may have a simple cold for several days and then one night unexpectedly develop a loud, barking cough. The swelling and narrowing of the airway may make breathing difficult. One of the cold viruses is typically the cause. These viruses spread by respiratory secretions or droplets in the air.

The condition primarily affects children younger than 5 years old because their small airways are more susceptible to narrowing when swollen. Adults may simply have a cold with laryngitis, but children may develop croup.

Croup comes on strongest during the nighttime and may last from 5 to 7 nights. Croup usually occurs in the fall or winter. Recurring croup is called spasmodic croup.

Children's Health Center Laryngitis

Signs and Symptoms

Signs and symptoms of croup may include:

• Loud, harsh, barking cough
  
  
• Mild to moderate difficulty with breathing, especially noisy when inhaling
  
  
• Low-grade fever
  
  
• Hoarse voice
  
  
• Sore throat, especially after coughing spells
  
  
• Chest discomfort from coughing

A characteristic sign of croup is a cough resembling the barking of a seal. The cough tends to be dry, not producing secretions. Coughing spells last about an hour and can fluctuate between mild and severe throughout the night. Most children with croup will have a cough for at least several nights before the illness subsides.

Croup is usually preceded by signs and symptoms similar to those of a cold, such as a runny or stuffy nose. If a young child with a cold becomes hoarse, be ready for croup to develop that night.

Usually the breathing difficulty is only mild to moderate. If breathing difficulty is severe, you may need to be ready for middle-of-the-night emergency care.

Cold

Causes

Croup is caused by many of the same viruses responsible for colds. The most common viruses are parainfluenza viruses. Parainfluenza viruses spread by respiratory secretions or droplets in the air as the result of coughing, sneezing or breathing.

Respiratory syncytial virus (RSV) is a cold virus that may merit checking for in some infants, but RSV rarely causes croup.

Respiratory syncytial virus

Risk Factors

Children 5 years old and younger are at greater risk of getting croup because it's easier for their small airways to swell, making breathing difficult. Symptoms are most severe in children 3 years old and younger. The peak age for croup is around 18 months. About 5 percent of children develop croup during their second year. Boys tend to have more infections or worse infections than girls do.

Croup can occur anytime of the year but it's most common between late fall and winter when viruses that cause croup are more prevalent.

When To Seek Medical Advice

Most cases of croup aren't life-threatening, and you can treat them at home without medication. However, if your child develops a severe case of croup, seek immediate medical attention.

With severe croup, your child may make noisy, high-pitched breathing sounds when inhaling (stridor). Because cases with stridor can worsen and close off the airway, seek medical treatment if your child develops stridor or the following signs and symptoms:

• Drooling or difficulty swallowing because the child's throat is so sore
  
  
• Increased difficulty breathing
  
  
• Worsening cough
  
  
• Blue or dusky colored skin around the nose or mouth

Croup shouldn't cause an infant or child to turn blue or develop a dusky hue to their lips and mouth. If this happens, don't wait until morning to see your doctor. Seek medical attention right away.

After a bad night with croup, most children feel much better in the morning. If your child is still having difficulty with croup during the day, check with your child's doctor. It might be time to start medical treatment or have your child undergo further evaluation.

Complications

The biggest concern with croup is whether severe breathing difficulty will develop. Some infants and children with severe croup may need to be admitted to an intensive care unit for observation and breathing treatments. Extremely severe croup can result in life-threatening swelling of the airway.

Ear infection and pneumonia are complications of croup that may occur as the respiratory symptoms are fading. The virus that causes croup may spread to the lungs or upward to the nose and to the ears.

Middle ear infection Pneumonia

Treatment

If you've taken your child to the doctor because self-care steps haven't relieved your child's symptoms, your doctor likely will prescribe a corticosteroid such as dexamethasone. Corticosteroids are medications used to provide relief for inflamed areas of the body.

Croup is caused primarily by a virus, and antibiotics won't help because they're used to treat bacterial infections. Cough syrup also is unlikely to help.

If your child's croup is serious, your child may be placed in a humidified oxygen tent. The tent may distress some infants or children, so holding your child in your lap and placing the cool mist nearby often works best. Some children may need a breathing treatment using epinephrine (adrenaline). Epinephrine is a medication that helps reduce swelling of the air passages.

Less than 5 percent of children who are admitted to the hospital for treatment of croup might need a tube to be placed into the windpipe until the swelling subsides (intubation). An even less common treatment of severe croup is to have the child breathe a combination of oxygen and helium until the breathing difficulty subsides.

If your child needs care in the doctor's office, emergency room or hospital, plan to stay with your child. Croup is scary for children, and your calm reassurance is important. Bring a favorite blanket or toy, sing your child lullabies or read quiet stories to help distract and comfort your child.

Prevention

No vaccine is available to prevent viral croup. Frequent hand washing and avoiding contact with others with respiratory infections are good ways to prevent colds and croup.

Immediate attention to a noisy cough is probably the best prevention for croup. Give your child extra fluids and expose him or her to warm, moist air to help soothe a noisy cough.

Hand washing: The simplest way to avoid infection

Self Care

If your child has croup, stay calm and keep your child calm. Crying only makes breathing more difficult for your child, so do your best to comfort or distract him or her — cuddle, read a book or play a quiet game. Also, you may want to sleep nearby or in the same room as your child so that you're alert to any worsening of the condition.

If your child awakens with croup, try these initial steps:

• Create moist air for your child to breathe. Run the shower or tub faucet to make the bathroom humid. Sit your child in your lap and read a book or sing a lullaby. Most children will breathe much more easily within 10 or 15 minutes. Once their breathing becomes easy, they can return to bed.
  
  
• Alternatively, try exposure to cold air. Sometimes breathing fresh, cool air helps. Wrap your child in a blanket and walk outside for a few minutes in the cool night air. This often causes prompt improvement.
  
  
• Place your child in an upright position. Sitting upright makes breathing easier. Infants may be placed in a child seat.
  
  
• Offer fluids. Warm fluids, such as a favorite soup, may be soothing and help loosen thickened secretions. Alternatively, if your child loves ice pops, now may be the time for a special cool treat. Children may be reluctant to drink milk when they have a cold because milk seems too thick, but if your child wants milk, it's OK to drink it.
  
  
• Use over-the-counter (OTC) pain relievers. OTC pain relievers such as acetaminophen (Tylenol, others) may help relieve a sore throat and improve your child's ability to drink fluids.
  
  
• Maintain a smoke-free environment. Keep your child away from smoke because smoke may aggravate symptoms.

Expect to have at least two or three bad nights before your child improves. Many parents are relieved when their child seems to have improved the day after the first night of croup, but then become worried because croup returns the next night. Be ready for another bad night, but after your child has had at least one or two good nights, you've probably made it through croup.

Home humidifiers: Help or hazard? Infant congestion

— September 13, 2002 —