Croup

What Is Croup?

Kids with croup have a virus that makes their airways swell. They have a telltale "barking" cough (often compared to the sound of a seal's bark) and make a high-pitched, squeaky noise when they breathe. Children can also sound hoarse (lose their voice or get a scratchy voice).

Most kids with croup (KROOP) get better in a week or so.

What Are the Signs & Symptoms of Croup?

At first, a child may have cold symptoms, like a stuffy or runny nose and a fever. As the upper airways — the voice box (larynx) and windpipe (trachea) — become irritated and swollen, a child may become hoarse and have the barking cough.

If the airways continue to swell, breathing gets harder. Kids often make a high-pitched or squeaking noise while breathing in — this is called stridor. They 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.

What Causes Croup?

The same viruses that cause the common cold also cause croup. Most often seen in the fall, croup can affect kids up to age 5. Viruses that cause croup spread easily from person to person when a sick person sneezes or cough and releases virus-filled droplets into the air.

There are two types of croup, viral croup and spasmodic croup, both of which cause the barking cough.

How Is Croup Diagnosed?

Health care providers listen for the telltale cough and stridor. They'll also ask if a child has had any recent illnesses that caused a fever, runny nose, and congestion; and if the child has a history of croup or upper airway problems.

The doctor might order a neck X-ray if the croup is severe and slow to get better after treatment. In cases of croup, an X-ray usually will show the top of the airway narrowing to a point, which doctors call a "steeple" sign.

How Is Croup Treated?

Most cases of croup are mild and can be treated at home. Try to keep your child calm, as crying can make croup worse.

For a fever or throat discomfort, medicine such as acetaminophen (or, only for kids older than 6 months, ibuprofen) may make your child more comfortable. Ask your health care provider how much to give and follow the directions carefully.

Breathing in moist air can help kids feel better. To help your child breathe in moist air:

• Use a cool-mist humidifier or run a hot shower to create a steam-filled bathroom where you can sit with your child for 10 minutes. Breathing in the mist will sometimes stop the severe coughing.
• In cooler weather, taking your child outside for a few minutes to breathe in the cool air may ease symptoms. You also can try taking your child for a drive with the car windows slightly lowered.

Your child should drink plenty of liquids to prevent dehydration. If needed, give small amounts of liquid more often using a spoon or medicine dropper. Kids with croup also should get lots of rest.

Some kids need a breathing treatment that can be given in the hospital or a steroid medicine to reduce swelling in the airway. Rarely, kids with croup might need to stay in a hospital until they're breathing better.

Antibiotics are only effective against bacteria so do not work to treat croup.

When Should I Call the Doctor?

Most kids recover from croup with no lasting problems. But some kids — especially those who were born early, or have asthma or other lung diseases — can be at risk for problems from croup.

Call your doctor or get medical care right away if your child:

• has trouble breathing, including very fast or labored breathing
• is too out of breath to talk or walk
• has pulling in of the neck and chest muscles when breathing
• has stridor that is getting worse
• is pale or bluish around the mouth
• is drooling or has trouble swallowing
• is very tired or sleepy or hard to awaken
• is dehydrated (signs include a dry or sticky mouth, few or no tears when crying, sunken eyes, thirst, peeing less)