What is croup?

Mother holding young child Croup is a common childhood illness that causes swelling in the upper airway. This can cause a change in voice and characteristic “croupy” cough that sounds like a seal or bark. There are a number of viruses that have been found to cause croup, the most common being parainfluenza virus.

The infection can be associated with nasal congestion, cough, sore throat and fever. Upper airway swelling can cause children to have just a sore throat, or if more severe, can cause distress when breathing in. This type of difficulty breathing results in a high-pitched creaking or whistling sound when a child inhales (known as stridor) and a harsh cough that sounds like a seal’s bark.

This is different than the wheezing that occurs when a child has difficulty breathing air out of the lungs. Wheezing occurs in asthma, which is a problem in the lungs; stridor occurs in croup, which is a problem in the upper airway.

Who does croup affect?

Younger children are more affected by croup because their airways are smaller. A small amount of swelling in a narrow airway can make it hard to breathe, compared to a small amount of swelling in a wider airway, which may be only a minor irritation with no breathing problems.

Croup is most commonly seen in:

  • Children 6 months to 3 years old
  • The fall and winter months

How serious is croup?

Most cases of croup are mild and may just require parental guidance and reassurance. Mild symptoms include occasional barking cough, hoarseness, and stridor only when the child is active or agitated.

Symptoms are often worse at night and can wake the child from sleep.

Harsh cough and breathing issues with croup can sometimes be turned around with simple measures at home like cool air from an open window, steam from steaming the bathroom, or using a humidifier. Breathing issues with croup are worse when your child is upset or anxious. Doing whatever you can to calm them down will help.

Children with mild croup usually improve in three to seven days.

Croup can present with more severe symptoms and breathing issues that don’t resolve with simple home measures. If you have concerns about your child’s breathing, you should bring them for medical evaluation right away.

Can I treat croup at home?

In most cases, a child’s mild croup symptoms can be turned around with simple home remedies.

Dr. Hughes suggests the following:

  • Use a cool mist humidifier.
  • Take the child into a steamed bathroom.
  • Take the child outside into cool, moist, night air.
  • Encourage the child to drink lots of fluids.
  • Treat a fever with acetaminophen or ibuprofen, as instructed by your child’s provider.
  • Engage the child in a calming activity to keep them as quiet and calm as possible, which will make it easier for them to breathe.
  • Stay in close proximity to the ill child at nighttime to immediately assist the child if they begin to have difficulty breathing.

When does croup require emergency care?

Dr. Hughes says the majority of children who come to CHOP’s Emergency Department (ED) with croup are able to be discharged home after some medication and possibly an observation period. Frequently, by the time a family arrives at the ED, the swelling in the child’s lungs has lessened and their breathing issues have largely resolved due to their exposure to the cool outside air while en route to the hospital. These children are typically given a single oral dose of steroids to help the swelling in their throat go down and improve symptoms until the illness passes in a few days.

However, Dr. Hughes stresses that some children with severe croup do need medical treatment to improve their breathing. It is important to have them evaluated promptly at the Emergency Department. They may need a breathing treatment (racemic epinephrine) to calm their breathing and a period of observation to ensure symptoms do not recur. There are few children who are admitted to the hospital for recurrent treatment and observation, and the most severe cases may need additional breathing support.

According to Dr. Hughes, signs your child has severe croup include:

  • Difficulty breathing accompanied by a “barking” or “croupy” cough
  • Stridor (noisy breathing with inspiration) even at rest
  • Chest area around the collarbone and ribs pulling in with each breath (called retraction)

If a child has repeated bouts of croup, especially more than two illnesses a year, they are said to have recurrent croup and should be seen by a pediatric otolaryngologist, a doctor that specializes in conditions of the ears, nose and throat (ENT), to determine the underlying cause of the condition.

Learn more about croup.

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