Croup

1 What is Croup?

Croup is a viral infection of upper respiratory tract that is characterized by a cough resembling the sound of a barking seal.

The characteristic barking sound results due to obstructed breathing caused by swollen areas around the vocal cords (larynx), windpipe (trachea) and bronchial tubes (bronchi). A cough forces air through the narrowed passage resulting in a noise similar to a barking seal. Similarly, breathing through swollen airway produces a high-pitched whistling sound (stridor).

Croup most commonly affects younger children. Usually, a croup is non-serious and can be treated by home-care measures.

2 Symptoms

Initially, the signs and symptoms of a croup are similar to that of a cold. As the condition progresses, you can observe signs such as:

  • A loud barking cough caused by swollen vocal cords
  • Worsening signs at night 
  • Fever
  • Husky voice
  • Noisy breathing

The signs can be further aggravated by crying and coughing, as well as anxiety and agitation. If your child is younger than 3, the signs may be more evident. The symptoms usually last for not more than five days.

When to see a doctor?

Hospitalization is needed for about 5% of Croup affected children who reach the emergency department. If you observe following signs in your child, seek immediate medical care:

  • Noisy breathing (stridor) 
  • Excessive salivation or swallowing problems
  • Anxiety and agitation
  • Fatigue
  • Rapid breathing
  • Inability to breathe
  • Bluish or grayish discoloration of skin around nose, mouth or fingernails (cyanosis)

3 Causes

Croup is a viral infection, meaning that it is caused by a virus and most commonly by parainfluenza virus.

The virus transmits through airborne droplets produced when a sick person coughs or sneezes. Your child can also acquire the virus by touching a contaminated surface. The virus then enters your child’s body through your child’s eyes, nose or mouth.

4 Making a Diagnosis

Generally diagnosis of croup is made based on your child's breathing, chest sounds (using a stethoscope) and throat examination. Your child’s doctor may also recommend X-ray imaging or other tests to make sure if other causes are responsible.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information. 

Write down the names of all your medications, vitamins or supplements. 

What your doctor wants to know?

A clear talk with your child’s doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your child’s doctor, which include: 

  • What are the signs in your child? 
  • Does your child have fever or swallowing difficulty?
  • When did your child’s signs start appearing? 
  • Has your child's cough worsened over time? 
  • Does your child’s cough occur in a specific pattern, for example does it get worse at night?
  • Does your child have a history of a croup?
  • Do you remember if your child has been recently exposed to other sick children?
  • What are your child’s other medical conditions, if any?
  • Has your child been routinely vaccinated?

5 Treatment

Most cases of croup are treated by home-care measures. However, emergency care is required when the signs are severe and unresponsive to home remedies. The first thing you can do to your child is calming him/her down to prevent airway obstructions. Crying and agitation are known to aggravate your child’s condition. You may have your own ways of comforting your child such as holding, offering a toy or singing lullabies.

If the signs last more than 3 to 5 days or worsen, your child may be prescribed:

  • Injectable steroid to control airway swelling: A steroid drug called dexamethasone is usually recommended because its effects last longer (up to 72 hours). 
  • Nebulized epinephrine to be inhaled.

Severe cases of Croup may require hospitalization. Less commonly, your child may need a temporary breathing tube.

6 Prevention

You can implement the same strategies for preventing both croup and a cold or a flu. Ask your child to follow these tips:

  • Frequent hand-washing to prevent the entry and spread of virus.
  • Staying away from ill people.
  • Coughing or sneezing into cupped hand.

Also you may prevent croup in your child by getting him/her routinely vaccinated. Till now, no vaccine has been developed against parainfluenza viruses.

7 Lifestyle and Coping

Lifestyle modifications are necessary for your child in order to cope with croup.

Comfort your child during a Croup with these tips: 

  • Calm your child, stay calm by holding or cuddling. If you are not successful in comforting, try to distract him/her with a toy or something else.
  • Facilitate your child’s breathing by humidifying the air or holding in an upright position.
  • Provide fluid to your child: Water, breast milk or formula are the best source of fluid. You may also give soup or frozen fruit pops to older children.
  • Provide your child proper rest to hasten recovery. 
  • Consider using a medication to lower fever such as acetaminophen.
  • Do not use over-the-counter cold preparations for children below 2. 

8 Risks and Complications

There are several risks and complications associated with croup.

Risks

Age: Children between 6 months and 3 years are at the greatest risk of developing a Croup.

Complications

Difficulty breathing

Top