Croup

About Croup

Croup is a condition that swells and irritates the upper airways. The same viruses that cause the common cold also cause croup, and most cases happen in the fall and early winter.

Kids with croup have a telltale “barking” cough (often compared to the sound of a seal’s bark) and a raspy voice, especially when crying.

Croup usually affects kids 6 months to 3 years old, but sometimes older kids can get it. Most kids with croup can be comforted with humidified or cold air and by drinking lots of liquids.

There are two types of croup, viral croup and spasmodic croup, both of which cause the barking cough. Most cases of croup are viral.

Signs and Symptoms

At first, a child may have cold symptoms, like a stuffy or runny nose and a fever. As the upper airways — the voice box (larynx) and windpipe (trachea) — become inflamed and swollen, a child may become hoarse and have the barking cough.

If the airways continue to swell, it becomes hard for a child to breathe. The child may make a high-pitched or squeaking noise while breathing in — this is called stridor. A child also might breathe very fast or have retractions (when the skin between the ribs pulls in during breathing). In the most serious cases, a child may appear pale or have a bluish color around the mouth due to a lack of oxygen.

Symptoms of croup are often worse at night and when a child is upset or crying.

Diagnosis

Doctors usually diagnose croup by listening for the telltale cough and stridor. They will also ask questions — for example, whether the child has had any recent illnesses that caused a fever, runny nose, and congestion; and if the child has a history of croup or upper airway problems.

When croup is severe and slow to get better after treatment, the doctor might order a neck X-ray to rule out other reasons for the breathing problems, such as an object stuck in the throat, a peritonsillar abscess (collection of pus at the back of the mouth), or epiglottitis (swelling of the flap of tissue that covers the windpipe).

In cases of croup, an X-ray usually will show the top of the airway narrowing to a point, which doctors call a “steeple sign.”

Treatment

Most cases of croup are mild and can be treated at home. Breathing in moist air can help kids feel better. If they have a fever, medicine (ibuprofen or acetaminophen) may make them more comfortable. Ask your health care professional how much to give and follow the directions carefully.

To help your child breathe in moist air, use a cool-mist humidifier or run a hot shower to create a steam-filled bathroom where you can sit with your child for 10 minutes. Breathing in the mist will sometimes stop the severe coughing. In cooler weather, taking your child outside for a few minutes to breathe in the cool air may ease symptoms. You also can try taking your child for a drive with the car windows slightly lowered.

Your child should drink plenty of fluids to prevent dehydration. If needed, give small amounts of liquid more often using a spoon or medicine dropper. Kids with croup also should get lots of rest.

Some kids need a breathing treatment that can be given in the hospital or a steroid medicine to reduce swelling in the airway. Rarely, kids with croup might need to stay in a hospital until they’re breathing better.

When to Call the Doctor

Most kids recover from croup with no lasting problems. But some kids — especially those who were born prematurely, or have asthma or other lung diseases — can be at risk for complications from croup.

Call your doctor or get immediate medical care if your child:

• has trouble breathing, including very fast or labored breathing
• has pulling in of the neck and chest muscles when breathing
• has stridor that is getting worse
• is pale or bluish around the mouth
• is drooling or has trouble swallowing
• is very tired or sleepy or hard to awaken
• is dehydrated (signs include a dry or sticky mouth, few or no tears when crying, sunken eyes, thirst, peeing less)