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Croup

About Croup

Croup is a condition that causes swelling and irritation of the upper airways — the voice box (larynx) and windpipe (trachea). It’s caused by the same viruses that cause the common cold. Kids with croup have a “barky” cough or hoarseness, especially when crying.

 

Croup is most common in kids 6 months to 3 years old, but some older children also get croup. Most cases happen in the fall and early winter.

There are two types of croup: viral croup and spasmodic croup. Both types cause a barking cough.

  • Viral croup always includes other signs of a cold, such as a runny nose, fever, and fatigue. The virus goes away within 3 to 7 days after it began.
  • Spasmodic croup may happen in a child with a mild cold. The barking cough usually begins at night and isn't accompanied by fever. Spasmodic croup has a tendency to come back again.

Most cases of croup are mild and can be treated at home. Rarely, croup can be severe and even life-threatening.

Signs and Symptoms

At first, a child may have cold symptoms, like a stuffy or runny nose and a fever. As the upper airways become inflamed and swollen, the child may become hoarse, with a harsh, barking cough. This loud cough often sounds like a seal barking.

If the upper airway continues to swell, it becomes hard for a child to breathe. The child may make a high-pitched or squeaking noise while breathing in – this is called stridor. A child also might breathe very fast or have retractions (when the skin between the ribs pulls in during breathing). In the most serious cases, a child may appear pale or have a bluish color around the mouth due to a lack of oxygen.

Symptoms of croup are often worse at night and when a child is upset or crying.

Diagnosis

Doctors usually diagnose croup by listening for the telltale barking cough and stridor. They will also ask questions, for example whether your child has had any recent illnesses with a fever, runny nose, and congestion, and if your child has a history of croup or upper airway problems.

If the child's croup is severe and slow to get better after treatment, the child may be sent to an emergency room (ER). A neck X-ray may be done to rule out  other reasons for the breathing problems, such as:

  • an object stuck in the throat
  • peritonsillar abscess (collection of pus at the back of the mouth)
  • epiglottitis (swelling of the epiglottis, the flap of tissue that covers the windpipe)

An X-ray of a child with croup usually will show the top of the airway narrowing to a point, which doctors call a "steeple sign."

Treatment

Most cases of viral croup are mild and can be treated at home. Breathing in moist air may help kids feel better, and pain medicine (ibuprofen or acetaminophen) may make them more comfortable. Kids should drink plenty of fluids to prevent dehydration, and rest often.

The best way to expose a child to moist air is to use a cool-mist humidifier or run a hot shower to create a steam-filled bathroom where the child can sit with an adult for 10 minutes. Breathing in the mist will sometimes stop a child from severe coughing. In the cooler weather, taking the child outside for a few minutes to breath in the cool air may ease symptoms. You also can try taking your child for a drive with the car windows slightly lowered.

In certain kids, doctors will prescribe steroids to decrease airway swelling. For severe cases, kids will be put on a breathing treatment that contains a medicine called epinephrine. This medicine quickly reduces swelling in the airways. Sometimes kids with croup will need to stay in a hospital until they’re breathing better.

When to Call the Doctor

Most kids recover from croup with no additional problems. But some kids, especially those who were born premature, or have asthma or other lung diseases, may have a higher chance of developing complications from croup.

Call your doctor or get immediate medical attention if your child has:

  • trouble breathing, including rapid or labored breathing
  • retractions, when the skin between the ribs pulls in with each breath
  • stridor, high-pitched or squeaking noise when inhaling
  • a pale or bluish color around the mouth
  • drooling or difficulty swallowing
  • is very tired or sleepy, difficult to wake
  • dehydration (signs include a dry or sticky mouth, few or no tears, sunken eyes, thirst, no urine or only a little dark yellow urine for 8 to 12 hours)
Date reviewed: July 2016

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.

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