Croup Cough

Croup is a viral infection seen in children, characterized by a ‘croupy’ or ‘barky’ a cough and other symptoms. The virus affects the voice box or larynx and windpipe, resulting in respiratory infection.

It may affect bronchial tubes as well and is often associated with other symptoms like running nose and cough. It is common for children 6 months to 3 years of age. In some cases, older children may also get this infection.

The loud, barking sound is caused by the inflammation of the voice box and the windpipe. As coughing forces air through the narrow windpipe, barking sound is produced by the swollen voice box.

Inhaling also produces a whistling sound, called stridor, as air moves through the narrow airways. In most of the cases, croup is not a serious condition and resolves with home treatment.

Croup symptoms often start with common cold. The loud, barking sound is produced once the swelling in the larynx is significant enough. Cough aggravates in the night and affects the sleep of the child.

A cough worsens with crying, agitation, and anxiety. Thus, one leads to the other making a cycle of symptoms. It is also associated with fever and hoarse voice. The child may find it difficult to breathe.

The symptoms of croup are more prominent in children younger than 3 years old, as the airways are small and narrow. The symptoms persist for 3-5 days before it is resolved.

Immediate medical attention is required if croup is associated with: 

• Noisy breathing called stridor
• Difficulty in swallowing
• Excessive drooling
• Anxiety or agitation
• Fatigue
• Difficulty in breathing
• Cyanosis, or bluish-colored skin around nose or fingernails

Croup is caused by a virus, most commonly parainfluenza virus. It spreads through contaminated droplets of a cough or sneeze that suspend in the air. It may also spread from surfaces, like toys, that contain the infected droplets.

Touching the contaminated surfaces and then touching face enables the spread of the infective virus. It is more common among children who are one year old. In most of the cases, the symptoms remain mild, but in some cases, inflammation may be severe and affects breathing.

Symptoms and physical examination indicate the viral infection that causes croup. The barking sound associated with a cough is the most characteristic feature associated with this cough.

The doctor may be able to identify the condition even over the phone. To ensure that blood oxygen supply is adequate, the doctor may place an oximeter on finger or earlobe.

Home treatment helps to resolve the symptom of croup. Allow the child to relax during an attack of a cough, as crying or anxiety can increase the swelling on vocal cords leading to worsening of the symptom.

Inhalation of warm, moist air helps in easy breathing. Inhaling cool, night air also may be of help. Having plenty of fluids helps to alleviate the symptom.

Avoid smoking and over-the-counter cough syrups as these are not helpful for the child. When home treatment does not help in resolving the symptom, glucocorticoids and epinephrine are given to decrease the swelling in the vocal cords.

Croup is caused by a viral infection that affects the vocal cords or larynx, windpipe or trachea, and bronchial tubes. The infection leads to inflammation of vocal cords and obstruction of the windpipe.

As it affects all three parts, it is referred to as laryngo-tracheo-bronchitis. The most common cause of croup is parainfluenza virus. Four different strains of this virus – parainfluenza I, II, III, and IV – are implicated in the development of croup in children.

Among the four strains, parainfluenza I is the most commonly associated organism. As in the case of common cold and other airborne viruses, parainfluenza spreads by inhaling droplets of sneeze and cough contaminated with the virus.

Other viruses may also lead to a barky cough. This includes flu viruses, influenza A and influenza B. In children who are not immunized against measles virus, it may lead to croup during infection.

The virus that causes the common cold, rhinovirus, is also implicated in the development of croup. Enteroviruses, that cause common cold-like symptoms, may also cause croup.

Respiratory syncytial virus or RSV, the cause of severe respiratory trouble, is another cause of croup in children. This virus is a cause of pneumonia in small children.

Some of the less common causes of croup include:

• Inhalation of foreign bodies likes peanut or a small pen cap
• Inflammation of epiglottis, the small flap on windpipe that prevents the entry of food particles into the tube
• An allergic response to allergens likes dust mites or pollen
• Inhalation of chemicals or other respiratory irritants
• Acid reflux, the process in which stomach acid moves back into the food pipe

Croup is an infectious disease and spread through airborne contaminated droplets. Symptoms of croup often develop within 2-3 days of exposure or inhalation of the particles.

Accidently touching the surfaces contaminated with the droplets also help in the spread of the virus to other people. The incubation period is around 2-3 days before the onset of symptoms.

It usually affects children in the age group of 6 months to 3 years. One-year-old children are the most commonly affected group. In some rare cases, croup may affect infants below 6 months of age and children above 15 years.

Adult croup is very rare. It is commonly seen during late autumn or early winter. Boys are most commonly affected by croup when compared to girls. A child may get two or more events of croup in a year.

Symptoms and physical examination are the methods used to detect croup. Symptoms like hoarse voice, stridor, barking sound while coughing, and low-grade fever is characteristic of this condition.

The child may have a high fever and tend to sit positioning himself forward. Excessive drooling may also be a presenting symptom for croup. Medical history with information on chances of exposure to the causative virus helps in the diagnosis.

Laboratory tests are not commonly used in the diagnosis of croup. If used, it is limited to the situation where chances of secondary bacterial infection are suspected. The secondary infection is superimposed on viral infection.

Confirmatory diagnosis of croup is the characteristic elongated narrowing of windpipe seen in x-ray images. The windpipe can be directly visualized by an otolaryngologist if needed.

The procedure used for directly viewing the windpipe is fiberoptic laryngoscopy and is used when there is a doubt of malformation of airways. It is also used when a foreign object is blocked in the windpipe.

Fibroptic laryngoscopy is suggested when there is a rapid deterioration of health in the child, or when the patient does not respond to conventional treatment. Information on immunization also helps in the diagnosis.

This is particularly true of children who are not immunized against Haemophilus influenzae type B. Those who are not immunized against the virus have increased chances of epiglottitis, a bacterial infection of the epiglottis.

The first step in the treatment of croup is comforting and soothing the child, as crying worsens the symptoms of the condition. Close monitoring of the child is equally important as breathing difficulty may develop all on a sudden and worsen.

Placing a warm mist vaporizer may help the child in breathing. Humidified air helps to reduce the inflammation on vocal cords, thus alleviating cough. Breathing cool night air also is helpful in reducing the symptoms. This is particularly useful when the symptoms worsen at night.

Breathing is often affected by the blockage of the nasal cavities by mucus. Instilling home-made salt water nasal drops into the nasal cavities and then suctioning with bulb syringe after few minutes helps to open us the passages for easy breathing.

A cough and cold medicines should be avoided as they are not effective in children with croup. On the other hand, these medications may have side effects that are more serious than the condition itself.

Fever and pain can be relieved using acetaminophen and ibuprofen. For severe croup, oral cortisone may be recommended. Inhalation therapy with epinephrine helps to relieve severe form of respiratory illness.

This is usually done in a hospital setting under continuous monitoring. Antibiotics are recommended only when a secondary bacterial infection is suspected. Dehydration is avoided by having plenty of fluids.

The child is encouraged to rest and restrict activity. For very severe cases of croup, hospitalization may be required. A temporary breathing tube may be placed in the windpipe to aid in breathing.

As the infectious virus is transmitted through droplets of sneeze and cough, avoiding direct contact and proximity to infected children is the best way to prevent croup. Avoid exposure to objects contaminated with the infectious virus to prevent the spread of croup.

Prognosis of croup is very good and most cases can be managed with home treatment and remedies. An emergency or doctor’s visit is required only if the symptoms worsen over time. In most of the cases, symptoms will be relieved with home treatment.

If the symptoms worsen even with home treatment or if it persists for a long time, it is better to give medical attention as soon as possible. This is particularly important if the child cannot cry or talk due to labored breathing or if the child has excessive drooling.