Croup (pronounced CROOP) is a respiratory condition that most commonly affects children ages 6 months to 5 years old.
It is a swelling of the upper airway (the larynx and trachea) that typically occurs in response to a cold virus. The hallmark symptom of croup is a dry, barky cough, much like the sound a seal makes. This cough often comes on suddenly, is typically worse at night, and may be accompanied by a runny nose, hoarse voice, and/or fever. These symptoms alone, without any signs of noisy or labored breathing, are considered mild croup.
As croup progresses, you may begin to hear a sound called stridor (pronounced STRY-dur). This is a high-pitched sound that happens when your child inhales. Stridor is a sign that airway swelling is worsening. If you can hear stridor when your child is upset or crying, but you no longer hear it when they are calm, then they may have moderate croup.
Croup is severe if you can hear stridor even at rest. A child with severe croup may also exhibit faster than normal breathing and/or retractions.
Retractions are a sign of respiratory distress. You can spot retractions by looking at the area above your child’s collarbones and/or beneath their ribcage, which appear to suck in and out with each breath. The cold viruses that are most likely to trigger croup are parainfluenza, respiratory syncytial virus (RSV), and adenovirus. More recently COVID-19 has been noted as a potential trigger for croup.
Oftentimes, you may never know which particular virus is triggering your child’s croup. However, the treatment for croup is fairly standard regardless of which virus is responsible.
TREATMENT FOR CROUP
- Mild croup (barky cough WITHOUT any stridor): Most cases of mild croup can be managed at home. The goal is to keep your child comfortable, well hydrated, and to decrease agitation. You can give them over-the-counter fever reducers (i.e. Motrin or Tylenol), encourage them to drink clear fluids, run a cool mist humidifier in their sleep space, sit in a steamy bathroom together, and generally try to keep them calm. Sometimes brief exposure to cold air (such as stepping outside into the cool night air, or standing in front of an open freezer door) can help ease your child’s cough.
- Moderate croup (barky cough with stridor that occurs ONLY when your child is agitated): A child with moderate croup should see their healthcare provider promptly. They may administer or prescribe an oral steroid, which is a type of medication taken by mouth that reduces airway swelling and thereby lessens cough and stridor.
- Severe croup (barky cough WITH stridor at rest, and possible signs of distress such as fast breathing or retractions): Emergency treatment is needed. A child with severe croup likely needs an oral steroid plus an inhaled breathing treatment that can only be administered in a hospital. Take your child to the nearest emergency room, or call 911 if they are struggling to breathe, appear weak or disoriented, or their skin is pale or blue.
FOLLOW UP CARE
With appropriate treatment, croup typically resolves in about 3 days, although runny nose, vocal hoarseness and/or fever may last a few days longer.
To prevent the spread of viral illness to others, your child should stay home from daycare or school until they are fever-free for at least 24 hours (without the use of fever reducers) and their symptoms are generally improving. If your child’s symptoms are not improving with treatment, are lasting longer than expected, or are getting worse, they should be seen by their healthcare provider.
Croup can be scary for kids and parents alike. Anything more severe than mild croup needs medical attention.
Never hesitate to call your pediatrician’s office, or take your child to an urgent care or emergency room if you feel their symptoms need attention right away. With the right treatment, your child should be feeling better soon.
Q: Croup is going around my child’s daycare. Is croup contagious?
A: The viruses that cause croup are contagious. However, two children can get infected with the same type of virus, and one may develop croup while the other may not.
Q: Can I give my child cough suppressants to ease their cough?
A: According to the American Academy of Pediatrics (AAP), children under 6 years old should not take medicated cough suppressants (Robitussin, Dimetapp, or Delsym for example). Studies have indicated that they are not effective in this age range and could have dangerous side effects like dizziness or drowsiness. For children ages 1-6, giving a spoonful of honey a few times a day is a safe and effective alternative to cough medicines. Never give honey to an infant under 1 year old.
Q: Is croup the same as asthma?
A: Croup and asthma are not the same. Croup is a brief, age-specific phenomenon that affects the upper airway. Once children are 5-6 years old, their airway typically matures in such a way that croup no longer occurs. Asthma is a chronic, typically life-long condition that affects the lungs. Asthma is a diagnosis that is made over time, with recurrent symptoms such as cough, wheezing and/or chest tightness often triggered by colds, allergens, or exercise.
Q: What can I do to prevent croup?
A: There is no hard and fast way to prevent croup. Your child’s best defenses are the measures used to prevent general illness, such as frequent hand washing, staying away from others who are sick, and keeping their immunizations up to date, including influenza and COVID-19 vaccines if they are eligible.