Croup: Making a Diagnosis

Croup: Making a Diagnosis

Croup is a common viral infection among children. It causes inflammation and swelling of the trachea (windpipe) and larynx (throat). As a result, a barking cough and noisy breathing often occur. Children under five years old are the most susceptible to the condition.

Children who contract croup usually experience cold-like symptoms in the beginning stages. These symptoms, including a cough, runny nose, and a slight increase in body temperature are observed prior to the telltale croup symptoms. Due to the virus that causes croup, the trachea and larynx swell up, which is a significant symptom of croup. The swollen area is being affected by the virus. They are often perceived as a minor cold and runny nose before a stridor and barking cough take over. The symptoms are usually worse during the night. The symptoms will get better on their own within 3 to 5 days but may last for a week.

Moreover, it is also observed that some children develop a mild fever even after the main symptoms are no longer in effect. Age plays a major factor in deciding the severity of the symptoms. Children who are 3 years old or younger tend to have more severe symptoms than other children who are older than this age group. Mostly, children will experience mild symptoms such as an occasional barking cough (typical in croup), a little stridor while resting, and very less indrawing of the chest wall. If a child's croup is severe, then the symptoms that are most likely to be seen are fast and difficult breathing, prominent stridor, unusual restlessness, and the chest wall of the child will be sucked in (chest wall retractions). However, if the condition is only mild, the child's symptoms will progress into a difficulty in sleeping, breathing, and will have a barking cough that could persist for multiple hours.

Causes of Croup

Croup is caused by a number of viruses but the most common cause of the condition is the parainfluenza virus. Some of the viruses that often cause the common cold and flu can also become the reason of spreading the infection. Croup doesn’t occur in a particular season or in other words, it is not a seasonal disease and children can have it at any time of the year. However, it generally occurs in children during the season of fall and winter. The most common mode of transmission is through inhalation or direct exposure to the infected droplets from coughing or sneezing children, which shows that it is a communicable disease. It can also spread among children by using the same utensils for eating and drinking, playing the same toys, and by shaking hands. Children who have croup are most contagious during the first two days of their illness and as the illness prolongs, its effectiveness also decreases with time. 

Why are children most commonly affected?

A human body’s airway is narrow during childhood. Croup is a disease that causes one's airway to swell and narrows the breathing tube further. For this reason, children are most commonly affected since they already have a narrow airway. As the condition progresses, thick mucus accumulates in the airway aggravating the inflamed area and worsening the symptoms already present, making breathing difficult.

The symptoms of croup include:

  • noisy breathing
  • hoarse voice
  • difficulty in breathing
  • a harsh, barking cough

Croup is usually mild and not a dangerous condition. However, an affected child must be seen by a doctor immediately to resolve the symptoms and halt further progression of the infection.

When to Seek Medical Attention

Seek medical help if your child:

  • has a fever
  • makes unusual noise when breathing (particularly while breathing out)
  • has swallowing difficulties
  • is anxious, restless, and sweating
  • begins drooling (more than the normal amount)
  • struggles to breathe
  • breathes faster than normal
  • develops a bluish skin color around the mouth, nose, or fingernails (signs of cyanosis)

How is croup diagnosed?

Croup can be easily diagnosed by a doctor through a physical examination. Physicians may even be able to recognize the telltale barking cough over the phone.

To diagnose croup, a doctor must observe the child’s breathing and listen to the child's lungs' sound using a stethoscope. The doctor will also examine the child's throat and ask for a description of the child's symptoms. If the symptoms of croup are constantly present, an X-ray or other tests may be ordered to rule out other possible respiratory conditions such as epiglottitis, subglottic stenosis, bacterial tracheitis, and angioedema, which also cause airway obstruction. The child's doctor may also place a pulse oximeter on the child’s earlobe, finger, or toe to make sure that his or her blood is receiving enough oxygen. When an X-ray of the neck is done on a croup patient, it may show a steeple sign, which is a characteristic of croup that shows the narrowing of the windpipe. The steeple sign is also commonly seen in children with subglottic stenosis. Viral cultures and blood tests are not highly suggested for croup because they may agitate the child and aggravate the already compromised breathing tube.

If a child does not improve through standard treatment for croup, their symptoms may be caused by a bacterial infection and they should be taken back to the doctor for further examination. 

How is croup treated?

Croup is not usually seen as a cause for alarm in the medical community. It is a mild condition, which can often be managed safely at home. Parents often know their child better than anyone else and are able to soothe and calm the child more easily. This comfort is important for the child's health and safety because crying can aggravate croup and can lead to further difficulties in breathing. Breathing in steam or warm humid air may also alleviate some of the symptoms of croup and may help open the patient's airway. The parents of the children with croup should ensure to isolate their child from secondhand smoke, which could aggravate their inflamed airways. Attacks of croup often occur at night, so it is recommended for parents to sleep beside their child or sleep near their child’s room for monitoring purposes.