Your Health

Croup

(Laryngotracheobronchitis)

Definition

Croup is swelling in the voice box and wind pipe. The swelling can make it difficult to breathe. This can cause a barking cough.
Upper Respiratory System in a Child
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Causes

Croup is caused by viral infections such as:

Risk Factors

Croup occurs most often in children between age 6 months and 3 years. This is because young children have a smaller airway. Airways become wider as children grow. This decreases the chance of croup in older children and adults.
Factors that may increase the risk of croup include:

Symptoms

Croup often begins with symptoms similar to an upper respiratory infection. The symptoms can come on suddenly and often at night. The following is a list of common croup symptoms:
  • Cough spasms
  • Cough that sounds like a barking seal
  • Hoarseness
  • Fever
  • A harsh, high-pitched sound when your child breathes in, especially when crying or upset
  • Trouble breathing, especially breathing in
  • Poor appetite and fluid intake
More serious symptoms of croup that may require immediate medical attention include:
  • Bluish color of nails, lips, or around the mouth—This is an absolute emergency. Call 911 .
  • Decreased alertness—This is also a serious symptom. Call 911 .
  • Restlessness or agitation—This can be due to dangerous lack of oxygen.
  • Struggling for each breath
  • Harsh, high-pitched breath sounds even at rest
  • Trouble swallowing
  • Drooling
  • Inability to speak due to trouble breathing
  • Nausea and vomiting
  • Lightheadedness
  • Rapid, irregular heartbeat; chest pain
  • Rash or hives
  • High fever

Diagnosis

You will be asked about your child's symptoms and medical history. A physical exam will be done.
Tests are not always needed. If croup is severe or not clear, your doctor may request:
  • Blood tests—to check for signs of infection
  • Neck x-rays —to look for changes associated with croup
  • Laryngoscopy —a thin tube inserted into your mouth to look at throat tissue. A sample of mucus from your wind pipe may be taken. It will be tested for infection.

Treatment

The goal is to keep your airway open until the infection clears. The infection causing croup will resolve on its own in 5-7 days. Severe symptoms usually resolve in 3-4 days.
Treatment options include:

Home Care

Your child may have trouble sleeping because of breathing difficulties. Moist air may help your child breathe easier. The following methods may help:
  • Use a cool humidifier in the bedroom.
  • Use your bathroom as a steam room. Bring your child into your bathroom and close the door. Turn the shower on the hottest setting. Sit in the steamy bathroom with your child. Your child's breathing should improve within 15-20 minutes.
  • Cool night air may also help. Sit with your child near an open window or step outside.
Make sure your child has plenty of fluids. Choose water and unsweetened juices.

Medication

The doctor may recommend medications, such as:
  • Acetaminophen or ibuprofen—These ease discomfort. Follow instructions on bottle.
  • Steroids—These reduce swelling in the airways. They can keep a child from becoming sick enough to need hospitalization.
  • Racemic epinephrine—This is delivered through breathing treatments. It is temporary help until steroid medications start to work.
  • Antibiotics—These are not helpful against a virus causing croup. But, they may be needed if there is an accompanying problem like an ear infection or pneumonia .

Hospital Care

For serious croup, your child may need to be hospitalized. Hospital care may include:
  • Croup tent—cool, moist air delivered inside a plastic tent
  • Medications or breathing treatments—to treat inflammation and respiratory distress
  • Breathing tube—inserted into the throat to help keep the airway open
  • IV fluids
  • Monitoring oxygen level and heart rhythms
  • Tracheotomy —a surgical procedure to open the airway in children with severe breathing problems

Prevention

Croup usually occurs due to an upper respiratory infection. Take steps to decrease your child's chance of catching colds and flu. Wash your hands often. Avoid contact with people who have cold or flu when possible.
Yearly influenza immunization can prevent cases of croup due to influenza A. Influenza immunization is strongly recommended for all children between the ages of 6 months and 5 years.

RESOURCES

Healthy Children—American Academy of Pediatrics http://www.healthychildren.org

Kids Health——Nemours Foundation http://www.kidshealth.org

CANADIAN RESOURCES

About Kids Health—The Hospital for Sick Children http://www.aboutkidshealth.ca

Health Canada http://www.hc-sc.gc.ca

References

Croup. Family Doctor—American Academy of Family Physicians. website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/croup.printerview.all.html. Updated July 2013. Accessed September 17, 2014.

Croup. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 27, 2014. Accessed September 17, 2014.

What is croup and how is it treated? Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/health-issues/conditions/chest-lungs/pages/Croup-Treatment.aspx. Updated July 23, 2014. Accessed September 17, 2014.

Revision Information

  • Reviewer: Kari Kassir, MD
  • Review Date: 08/2014 -
  • Update Date: 09/17/2014 -