Croup is inflammation (redness and swelling) of the inside lining of the area near the voice box (larynx) and windpipe (trachea), the “upper” parts of our breathing system (respiratory tract). As the linings swell, these upper airways get narrower, causing noisy breathing, a hoarse-sounding voice, and a harsh, barking cough. These symptoms typically are worse at night, especially the first two nights of the illness, or when a child is upset or crying.
Known also as laryngotracheitis, croup usually is caused by a virus, most commonly the parainfluenza virus. Most cases of croup are mild, with a cough that gets worse at night but still can be managed at home. Sometimes, however, it becomes severe and the airways get too narrow, making it so difficult for a child to breathe that treatment in a hospital is needed.
Croup is diagnosed primarily in children between the ages of 3 months and 5 years, although older children and adolescents can contract it, too. Croup can occur at any time of the year, but is most common during the late fall and winter. Symptoms generally get better within five to seven days.
Symptoms of croup may include:
- Deep, barking cough (like a seal)
- Noisy, high-pitched breathing (stridor)
- Hoarse or raspy voice
- Runny nose
- Fever, usually mild or low grade
To know if your child has croup, the doctor will:
- Check your child’s temperature, since croup often causes a mild fever.
- Listen to your child’s cough, since croup always has a special cough that sounds like a barking seal. Doctors sometimes can diagnose croup over the phone just by listening to a child’s cough. Since the croup cough may be gone during the day, the doctor’s diagnosis will depend on how you describe the illness.
- Watch your child’s breathing. This includes:
- Counting how many times your child is breathing each minute (respiratory rate). Severe croup causes fast breathing.
- Checking if your child is showing signs of difficult or labored breathing, such as making whistling noises (stridor) when breathing in, using the muscles in his neck, chest or belly to help breathe (retracting), making grunting noises when breathing out, or flaring his nostrils.
- Listen to your child’s lungs to make sure they are clear, without wheezing or signs of chest infection.
- Consider further testing. If your child’s symptoms are severe or not what the doctor would expect, he may order an X-ray of the neck or chest to look for other problems.
If your child does have croup, the doctor will:
- Not prescribe an antibiotic, since viruses cause croup. Remember that antibiotics treat only bacteria, never viruses. If doctors use them unnecessarily for viral infections, bacteria will become resistant to them, and the antibiotics won’t work when they are needed to treat a future bacterial infection.
- Discuss whether any other medicines are necessary. Steroids (dexamethasone or prednisone) may be given by mouth or directly into the muscle by needle to help shrink the swelling of the linings of the voice box and windpipe to make it easier to breathe. For severe croup, a special medicine called racemic epinephrine can be given by a mist machine (nebulizer) in an emergency department or some doctors' offices. If this medicine is used, your child will be watched closely for a while because symptoms sometimes can worsen a few hours after the medicine is given.
- Recommend ways to make breathing easier and calm the cough.
- Discuss the things you should watch for at home.
- Tell you if your child should be seen again. Usually no follow-up visit is required if your child is feeling better.
Some over-the-counter medications may be helpful:
- For mild pain and fever, try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).
These over-the-counter medicines usually are not helpful:
- Cold medicines, including decongestants (pseudoephedrine), cough suppressants (dextromethorphan) and expectorants (guaifenesin), do not improve symptoms of croup.
- Antihistamines, for example, diphenhydramine (Benadryl), are useful for treating allergies but have not been shown to improve symptoms of croup.
Certain over-the-counter medications should not be used unless directed by your doctor:
- Herbal remedies such as Echinacea or goldenseal have not been well studied for treating croup in children and may have unwanted side effects.
- Throat sprays and cough drops that contain an anesthetic, such as benzocaine (Cepacol) or phenol (Cepastat, Chloraseptic), can help to numb any throat pain. However, the tongue and other parts of the mouth can become numb as well, making it more difficult for your child to eat or drink.
- Never give your child aspirin or any products containing aspirin because it has been associated with Reye’s syndrome, a serious illness that affects the liver and brain.
Other things you and your child can do that may help your child feel better:
- Use cool or warm mist to help decrease swelling of the linings of the voice box and windpipe, soothe the throat, and make airway mucous less sticky and easier to cough out.
- Sit with your child in the bathroom for 10 to 15 minutes with the door closed and the hot shower running, so that he can breathe in the warm moist air as it fills the room.
- Have your child breathe in the steam from a cool-mist vaporizer (humidifier) in her room, but make sure to clean it every few days according to the manufacturer’s instructions.
- If you have a nebulizer machine for asthma at home, use it with only salt water (saline) in it.
- Take your child outside for a few minutes to breathe the cold air, or open his bedroom window.
- Give your child lots of liquids — warm (broth, apple juice, lemonade or tea) or cool (milk shakes, gelatin desserts, flavored ices) — to soothe the throat and keep well hydrated.
- Do not smoke around your child because it will make croup worse.
- Does not improve after 15 to 20 minutes in the cool (or warm) mist.
- Is getting worse instead of better.
- Is having trouble breathing.
- Starts drooling or spitting, or cannot swallow his saliva.
- Is not drinking and has not made any urine in six to eight hours.
- Seems too sleepy or tired at those times when he usually would be awake and active.
- Continues to have fever, pain or trouble breathing two to three days after having seen a doctor.
Prevent other episodes of croup by:
- Teaching your child to always wash his hands regularly and well.
- Teaching your child to cover his mouth and nose when he coughs or sneezes.
- Using disposable tissues to wipe or blow noses (use once and then throw them away).
Check with your school or day care regarding specific policies about returning after illness. Although the viruses that cause croup are contagious (spread from person to person), children with croup usually can go back to school or day care as soon as they have no fever for 24 hours and feel well enough to be there.