Croup

This article covers the signs and symptoms of croup, the treatment and the complications that can occur in children with croup.   

What is croup?

Croup is a fairly common childhood complaint and is caused when a virus causes swelling in the trachea (windpipe) and larynx (voice box). Its medical name is laryngotracheobronchitis.

Croup is easily recognised due to the distinctive cough that it causes; it has been likened to the bark of a seal. This cough is caused by air passing through the swollen vocal cords.

Often croup will start with cold symptoms (runny nose, red eyes, fever) and 2 – 6 days later the croup cough will begin.

Croup will often be worse at night and worse when the child cries or becomes upset. It can be quite frightening for parents, as it often comes on suddenly. However, croup is usually a mild condition that can be treated at home, after seeing the doctor.

For decades mothers helped soothe children with croup by taking them into a bathroom filled with moist steamy air from a shower or bath, though medical experts now dispute there is hard evidence to say this actually helps. Undoubtedly the calming, quiet cuddle will definitely help to soothe the child.

Croup is more common in those under five and is more severe in children under three (as their airways are smaller). Croup is contracted by coming in contact with the virus from coughing or sneezing from infected children, or from touching toys or other contaminated objects.

Generally the croup will become better during the day and each successive night the symptoms become less severe. The first two nights are the worst and it generally lasts about 5 – 6 nights.

Croup can also be caused by allergies, gastric reflux or a foreign object that has become lodged in the airways.

In some cases croup can become severe. If you are ever worried about your child’s ability to breathe – call an ambulance immediately.

Signs and symptoms of croup

• Distinctive harsh cough – sounds like the barking of a seal
• Croup may begin with cold symptoms – runny nose and fever
• Coughing gets worse when your child cries or is upset
• Symptoms worsen at night
• Hoarse voice
• Child is very irritable

Call your doctor urgently for croup if:

• The child has stridor – this is characterised by squeaking, high pitched sound caused by the airway becoming partially obstructed
• You notice your child’s abdominal muscles and the area around the ribs are pulling hard in and out during each breath (this is called intercostal breathing and means your child is finding breathing difficult)
• Your child is breathing very fast

Call an ambulance if:

• Your child has become blue or pale around the lips – this is a sign they are not getting enough oxygen
• Your child is drooling or having difficulty swallowing
• Your child has a very high fever, is delirious or looks very ill
• Your child has become very agitated

Treatment for croup

• Take your child to the doctor
• Your doctor will decide if the croup is mild, moderate or severe by examining how well they are breathing, their colour, how alert or sleepy they are, how much air they are getting into their lungs and if there is any stridor
• An x-ray may also be ordered
•  If croup fails to clear, your doctor may order steroid treatment
• Sometimes croup is caused by a bacterial infection – if so, the doctor will prescribe antibiotics
• If croup is severe your child may need hospitalisation – treatment can include being put inside a humidified oxygen tent.

Risks and complications of croup in children

• Croup is more common in premature babies and in children with lung problems such as asthma
• Croup is also more common in children with Down’s Syndrome
• Complications can include ear infection and pneumonia – though these are quite rare
• Most often there are no long term complications from croup

How do you treat croup at home?

• Stay with your child to reassure and calm them
• Keep your child comfortable and calm – you can often calm the child enough so that he or she will go back to sleep
• Sit the child upright in your lap or in a chair to make breathing easier
• Sleep in the same room as your child so you can keep a close eye on them. This is especially important if your child has experienced any breathing difficulty
• Ensure the child keeps drinking fluids
• Make sure your child is getting plenty of rest
• The previous recommendation was to treat croup with warm steam. However, there is no evidence to support this and the Asthma Foundation now says that cool air sometimes helps children and suggests wrapping them in warm blankets and taking them into the cool night air for a short period
• Help prevent exposure to croup by using good hygiene and teaching your children to regularly wash their hands
• Keep your child away from anyone with croup – and if your child has croup keep them away from others
• The diphtheria, measles and Hemophilus influenzae vaccines help protect against the most severe forms of croup

Now that you know more about croup, you may want to arm yourself with more expert health advice, see our Common childhood illnesses section.