Definition

Croup is swelling in the voice box and wind pipe. The swelling can make it difficult to breathe. It can also cause a telltale 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:

  • Attending day care
  • History of croup
  • Family history of croup
  • Frequent upper respiratory infections like colds or sinus infections
  • Colder months: October through March

Symptoms

At first, croup may seem like a common cold. The symptoms can come on suddenly. They often appear at night. Symptoms of croup can include:

  • 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:

  • Call for emergency medical help right away if your child has:
    • Bluish color of nails, lips, or around the mouth
    • Decreased alertness
  • 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 health history. A physical exam will be done. The doctor may assume croup based on the symptoms.

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 caused by croup
  • Laryngoscopy—a thin tube is passed down the throat to collect sample and view area

Treatment

The infection will pass on its own in 5 to 7 days. Severe symptoms will usually pass in 3 to 4 days.

Treatment can help to lessen symptoms and keep airways open. Treatment options include:

Home Care

Breathing trouble can make it hard to sleep. Moist air may help a child breathe easier. The following methods may help:

  • Use a cool humidifier in the bedroom.
  • Use the bathroom as a steam room. Bring the child into the bathroom and close the door. Turn the shower on the hottest setting. Sit in the steamy bathroom with the child. Breathing should improve within 15-20 minutes.
  • Cool night air may also help. Sit with the child near an open window or step outside.

Encourage your child to drink plenty of fluids. Choose water and unsweetened juices.

Medication

The doctor may recommend:

  • Acetaminophen or ibuprofen—to ease discomfort. Follow instructions on bottle.
  • Steroids—to reduce swelling in the airways. They can decrease the need for a hospital stay.
  • Racemic epinephrine—through breathing treatments. It is temporary help until steroid medications start to work.
  • Antibiotics—not helpful if a virus is the cause. May be needed if there is there is another infection.

Hospital Care

A child with serious croup may need to stay in a hospital. Hospital care may include:

  • Breathing tube—inserted into the throat to help keep the airway open
  • IV fluids
  • Monitoring oxygen level and heart rhythms to spot problems early
  • Tracheotomy—an airway is created in the throat

Prevention

Take steps to decrease your child's chance of catching colds and flu. Wash your hands often. Encourage them to do the same. Avoid contact with people who have cold or flu when possible.

Yearly flu vaccines can prevent croup caused by flu. It is strongly recommended for all children between the ages of 6 months and 5 years.

Revision Information

  • Reviewer: EBSCO Medical Review Board Kari Kassir, MD
  • Review Date: 01/2018 -
  • Update Date: 08/24/2018 -