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In the Know - All about Croup

In the Know

All about…  Croup




Croup (rhymes with “troop”) is an infection of the upper airway that constricts breathing and causes its characteristic barking cough.  Croup typically occurs in younger children. 


But as scary as it may sound—parents whose children have had croup will tell you that its cough sounds scary—croup rarely is scary.  Most cases can be treated at home—with no harm done.


The cough and other symptoms of croup are the result of inflammation around the vocal cords, windpipe and bronchial tubes.  When a cough forces air through this narrowed passage, the swollen vocal cords produce a noise similar to a seal barking.  Likewise, taking a breath with croup often produces a high-pitched whistling sound.




Croup often begins as a typical cold.  


If there is enough inflammation and coughing, a child will develop a loud barking cough.  This often is worse at night, and is further aggravated by crying and coughing, as well as anxiety and agitation, setting up a cycle of worsening symptoms.


Fever and hoarse voice are common, too.  The child’s breathing may be noisy or labored.


Because children have small airways, they are most susceptible to having more marked symptoms with croup, particularly children younger than three years old.


Symptoms of croup usually last for three to five days.



When to see a doctor

As mentioned, the overwhelming majority of cases of croup, most of which are in children (but sometimes teens or adults, too), are harmless and go away on their own. 


But you should see your pediatrician if a child:

  • Makes noisy, high-pitched breathing sounds upon inhaling and exhaling

  • Has a fever along with ordinary croup symptoms

  • Has symptoms for more than seven days

  • Has severe coughing spells

  • Breathes at a faster rate than usual


Get immediate medical attention if a child:

  • Begins drooling or has difficulty swallowing

  • Struggles to breathe

  • Develops blue or grayish skin around the nose, mouth or fingernails


Approximately five percent of children who need the emergency room for croup will also need hospitalization.




Croup is usually caused by a virus infection, most often a parainfluenza virus.  (Parainfluenza is a group of four viruses that cause different infections in the upper or lower respiratory areas, with symptoms like those of the common cold—commonly leading to misdiagnosis.)


The infecting virus that causes croup is usually contracted by breathing infected respiratory droplets that were coughed or sneezed into the air by others.  Virus particles in these droplets may also survive on toys and other surfaces.  If a child touches a contaminated surface and then touches the eyes, nose or mouth, an infection may follow.



Risk factors

People most at risk of developing croup are children between the ages of six months and three years.  The peak incidence of the condition is around 24 months of age.




As mentioned, most cases of croup are mild.  In a small percentage of cases, the airway swells enough to interfere with breathing.




Croup is typically diagnosed by the doctor observing the child’s breathing, listening to his or her chest with a stethoscope and examining the child’s throat.  Sometimes X-rays or other tests are used to rule out other possible illnesses.




The overwhelming majority of cases of croup can be treated at home.  However, croup can be scary, especially if it lands a child in the doctor’s office.  Comforting the child and keeping him or her calm are important, because crying and agitation can worsen airway obstruction.  Hold the child, sing lullabies or read quiet stories.  Offer a favorite blanket or toy.  Speak in a soothing voice.


If the child’s symptoms persist beyond three to five days or worsen, his or her doctor may prescribe a type of steroid called glucocorticoid to reduce inflammation in the airway.  Benefits will usually be felt within six hours.  A glucocorticoid called Dexamethasone is usually recommended because of its long-lasting effects (up to 72 hours).  Epinephrine, which is administered in more severe cases, is also effective in reducing airway inflammation.  It’s fast-acting, but its effects wear off quickly; a child given epinephrine will be have to be observed for a period of time.


For rare cases of severe croup, the child may need to spend time in a hospital.  In even rarer instances, a temporary breathing tube may need to be placed in the child’s windpipe.



Lifestyle and home remedies

Croup often runs its course within three to five days.  In the meantime, keep the child comfortable with a few simple measures:

  • Stay calm.  Comfort or distract him or her—cuddle, read a book or play a quiet game.  Because crying makes breathing more difficult, the goal here is to prevent or limit crying.

  • Moisten the air.  Although there’s no evidence of benefit from this practice, many parents believe that humid air helps a child’s breathing.  You can use a humidifier or sit with the child in a bathroom filled with steam generated by running hot water from the shower

  • Hold the child in a comfortable upright position.  Hold the child on your lap, or place him or her in a favorite chair or infant seat.  Sitting upright may make breathing easier

  • Offer fluids.  For babies, water, milk or formula is fine.  For older children, soup or frozen fruit pops may be soothing

  • Encourage rest.  Sleep can help the child’s immune system fight off the infection

  • Try a fever reducer.  If the child has a fever, over-the-counter medicines like acetaminophen (Tylenol, others), may help

  • Skip the cold medicines.  Over-the-counter (OTC) cold preparations aren’t recommended for children younger than age two.  Plus, nonprescription cough medicines won't help croup


The child’s cough may improve during the day, but don’t be surprised if it returns at night.  Parents may want to sleep near the child or even in the same room so that they can take quick action if symptoms worsen.




Frequent hand-washing is the most important.  Also keep children away from anyone who’s sick, and encourage your child to cough or sneeze into his or her elbow.


To stave off more-serious infections, keep your child’s vaccinations current.  The diphtheria and Haemophilus influenza type b vaccines offer protection against the rarest but most dangerous upper airway infections.  There isn’t a vaccine yet that protects against parainfluenza viruses.


At the end of the day, preventing croup is simple: Just do what you do to prevent colds, flu and other infections.


The Gazette thanks Eliezer Gurkov, PAC, for critically reviewing this article.


Disclaimer: The medical information provided here does not substitute the advice of a medical professional.  When in doubt, consult your pediatrician.