Croup (page 2)

About Croup

Croup is a condition that causes an inflammation of the upper airways — the voice box (larynx) and windpipe (trachea). It often leads to a barking cough or hoarseness, especially when a child cries.

Most cases of croup are caused by viruses, usually parainfluenza virus and sometimes adenovirus or respiratory syncytial virus (RSV). Viral croup is most common — and symptoms are most severe — in children 6 months to 3 years old, but can affect older kids too. Some children are more prone to developing croup when they get a viral upper respiratory infection.

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

The term spasmodic croup refers to a type of croup that develops quickly and may happen in a child with a mild cold. The barking cough usually begins at night and is not accompanied by fever. Spasmodic croup has a tendency to come back again (recur).

Treatment of symptoms is the same for either form of croup.

Signs and Symptoms

At first, a child may have cold symptoms, like a stuffy or runny nose and a fever. As the upper airway (the lining of the windpipe and the voice box) becomes more inflamed and swollen, the child may become hoarse, with a harsh, barking cough. This loud cough, which is characteristic of croup, often sounds like the barking of a seal.

If the upper airway continues to swell, it becomes even more difficult for a child to breathe, and you may hear a high-pitched or squeaking noise during inhalation (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 children are upset or crying. Besides the effects on the upper airway, the viruses that cause croup can cause inflammation farther down the airway and affect the bronchi (large breathing tubes that connect to the windpipe).

Duration

Croup symptoms generally peak 2 to 3 days after the symptoms of the viral infection begin. Viral croup usually lasts 3 to 7 days.

Complications

The vast majority of children recover from croup with no complications. Rarely, a child can develop a bacterial infection of the upper airway, or pneumonia. Dehydration may follow inadequate fluid intake.

Children who were born prematurely or who have a history of lung disease (such as asthma) or neuromuscular disease (like cerebral palsy) are more likely to develop severe croup symptoms and often require hospitalization. Still, croup rarely causes any long-term complications.

Prevention

Frequent hand washing and avoiding contact with people who have respiratory infections are the best ways to prevent spreading the viruses that cause croup.

When to Call the Doctor

Immediately call your doctor or get medical attention if your child has:

• difficulty 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
• a fatigued appearance
• signs of dehydration (including a dry or sticky mouth, few or no tears, sunken eyes, thirst, no urine or only a little dark yellow urine for 8-12 hours, extreme tiredness)
• a very sick appearance

Reviewed by: Yamini Durani, MD
Date reviewed: June 2012