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Croup

What is croup?

  • Croup is an inflammation of the voice box (larynx) that may extend to the windpipe (trachea).
  • Several different viral infections, most commonly the parainfluenza virus, can cause croup.
  • When a child has croup, the airway just below the vocal cords becomes swollen and narrow leading to difficult and noisy breathing.
  • Children between the ages of 6 months and 3 years of age are most likely to get croup.
  • Croup occurs more commonly in the winter months.

How does a child get croup?

  • As with many upper respiratory tract infections, viruses are spread by respiratory droplets from an infected person’s nose or mouth.
  • The droplets can spread through the air directly onto another person, or may land or be placed on another surface, which is then touched by another person. If that person then touches his eyes or mouth, he can become infected.

How long will it take my child to become ill after being exposed to someone else with a viral infection that can cause croup?

  • Remember, just because your child is exposed to an ill person does not necessarily mean they too will become ill.
  • But if your child is to become ill, it will depend on the type of viral infection. For example, a child would become ill 2 – 6 days after being exposed to the parainfluenza virus.

What are the signs and symptoms of croup?

  1. Typically starts off with a cold and low grade fever
  2. Develops a barking cough
  3. Stridor – coarse musical sound with each breath
    - common with mild croup, especially when a child is
    crying or moving actively.
    - but if a child has stridor while resting, it can be a sign of
    severe croup.
  4. Difficulty breathing
  5. Drooling
  6. Difficulty swallowing
  7. Wheezing may be heard
  8. Decreased appetite
  9. Dehydration
  10. Fever may become high (over 102°F)

How can croup be diagnosed?

  • Croup is a clinical diagnosis meaning that the diagnosis based on the child’s age, signs and symptoms, and physical examination.
  • An X-ray of the neck may help make with the diagnosis but is most important in ruling out other causes for the child’s stridor.

What is the treatment for croup?

  • Plenty of rest and fluids (warm is better)
  • Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for discomfort or fever
  • A cool-mist humidifier may be beneficial. Water droplets penetrate the areas of inflammation in the voice box and provide moisture.

For breathing difficulties, including stridor, you can do the following interventions at home:

  1. Steam: Take your child into the bathroom. Close the door and turn the shower on the hottest setting to let the bathroom steam up. Sit in the steamy bathroom with your child. Within 15 to 20 minutes, the warm, moist air should help their breathing.
  2. Cool air: If the steam in the bathroom does not work, take your child outdoors for a few minutes. Inhaling moist, cool night air may loosen up the air passages so that they can breathe more freely.

If your child requires evaluation at your pediatrician’s office or the ER:

  • Your child may be given a special type of aerosol treatment with epinephrine to improve their breathing.
  • If your child is given an epinephrine treatment they will be required to be observed in the ER for approximately 2 hours to make sure the breathing difficulties do not return.
  • Your child may be given steroids as well (either by mouth or injection)
  • Antibiotics, which treat bacteria, are not helpful for croup.
  • Some children do require admission to the hospital for further aerosol treatment and observation.

How long will my child be sick with croup?

  • Croup usually lasts several days and is usually worse at night. The second and third nights are usually the worst.

When can my child return to daycare or school?

  • For croup, it will depend on how quickly your child’s symptoms go away, especially their
    fever and breathing difficulties.

When should I call my pediatrician concerning a barky cough in my child?

  • It is best to call for specific instructions when you first suspect that your child has croup that does not respond to the home treatments, as described above.
  • You should also call your doctor immediately if your child’s symptoms worsen such as drooling or difficulty breathing.
  • If your childs breathing becomes a serious struggle, call 911 immediately.

How can croup be prevented?

  • Frequent hand washing is recommended to decrease the chance of becoming infected. Click on how to prevent infection for more details.