Childhood Croup

1.    What causes croup?


Croup is an infection that starts like a cold and then progresses to the larynx (voice box). It causes swelling of the larynx area (vocal cord area) and thus is characterized by a harsh, barky, low-pitched cough, particularly worse at night. It can start suddenly at night before symptoms of a cold are even noticed. It is caused by a virus, often para influenza virus. It is most common in children ages 3 months to 5 years and is worse in infants who were premature, children under the age of 3(because of their narrow windpipes) or children who have asthma.  Croup is most common in the fall, winter and early spring.


2.    How do I know if my child has croup?


The illness may start with symptoms like the common cold, runny nose, low grade fever, fussiness. Not every cold will lead to croup in your child.  Croup then moves to a harsh, barky cough. Often the cough will be worse at night; perhaps your child will hardly cough during the day. Your child’s voice may also be hoarse.

The cough will usually last 5-7 days, with the day 2-4 being the worse. Most cases of croup are mild and can be managed at home.

Your child may also have difficulty breathing, noisy breathing or fast breathing. (Please refer to the section “When to see the physician”.)

If your child has a persistent cough, lasting longer than 5-7 days and with a “whoop” at the end of the coughing spasm, please make an appointment to see a physician. This type of cough is characteristic of pertussis.


3.    What can I do for my child if she/he has croup?


One of the best things you can do to help your child when he/she has croup is to make sure he/she drinks enough fluids. Your child may not have much of an appetite for solid food; as long as he/she is drinking plenty of liquids, don’t worry about food intake. Offering your child popsicles is a great way to encourage fluids when your child doesn’t feel well.

Often children with croup will be fine during the day, or just appear as if they have a cold. Then at night, the harsh barky cough presents. Sitting with your child in the bathroom while a hot shower is running may help. If that doesn’t help, you can try taking your child outside into cool weather. If the outside air is not cool, try opening the door of your freezer and let you child breathe in the cool air from the freezer. Cough medicines are generally NOT helpful. Remaining calm as a parent and thus keeping your child calm, is the most helpful.

Consider sleeping in the same room during this time, so you can know how your child is doing in the middle of the night. And of course, if you are ever concerned about your child’s breathing, seek urgent medical attention.


4.    When should I take my child to the doctor or emergency department?


If you are concerned about your child’s breathing and have tried the above remedies, take your child to your pediatrician (if during the day/evening) or to the emergency department (if during the night).  Anytime you, as a parent, are concerned about your child, you should seek medical attention.

Your child may make a high-pitched noise with each breath; this is called stridor and is different from wheezing. Stridor is caused by narrowing of the large airways where wheezing is caused by narrowing of the small airways. Stridor will become worse if your child is anxious; do your best to remain calm for your child.

Your child may have nasal flaring (the nose holes move in and out with each breath) and you may be able to see his/her ribs with each breath (intercostals retractions). Your child may be breathing more quickly than usual or may be less alert. These are all signs of difficulty breathing.

If your child has any of the above symptoms and they are not stopped with the above remedies, seek medical attention immediately. If your child is drooling, spitting or having difficulty swallowing, call 911. Also if your child’s lips are bluish in color, call 911.


5.    How can I prevent croup?


Your child is contagious as long as he/she has a fever. Croup is spread by being around someone else who has croup; the virus that causes croup is contagious but not all children who get this virus develop croup. For some children it’s merely a cold.

 Frequent hand washing is the best way to keep from getting croup. Antibiotics are not useful in preventing or treating croup.