Croup

Croup and Your Young Child

Croup is a common illness in young children. It can be scary for parents as well as children. The following is information from the American Academy of Pediatrics about croup, including types, causes, symptoms, and treatments.

What is croup?

Croup is a condition that causes a swelling of the voice box (larynx) and windpipe (trachea). The swelling causes the airway below the vocal cords to become narrow and makes breathing noisy and difficult. It is most commonly due to an infection.

Children are most likely to get croup between 3 months and 5 years of age. As they get older, it is not as common because the windpipe is larger and swelling is less likely to get in the way of breathing. Croup can occur at any time of the year, but it is more common in the fall and winter months.

Types of croup

Viral croup. This is the most common type of croup. It is caused by a viral infection of the voice box and windpipe. It often starts out just like a cold, but then slowly turns into a barky cough. Your child's voice will become hoarse and her breathing will get noisier. She may make a coarse musical sound each time she breathes in called stridor. Most children with viral croup have a low fever, but some have temperatures up to 104°F (40°C).

Spasmodic croup. This type of croup is thought to be caused by an allergy or by reflux from the stomach. It can be scary because it comes on suddenly, often in the middle of the night. Your child may go to bed well and wake up in a few hours, gasping for breath. She will be hoarse and have stridor when she breathes in. She also may have a barky cough. Most children with spasmodic croup do not have a fever. This type of croup can recur. It is similar to asthma and often responds to allergy or reflux medicines.

Stridor is common with mild croup, especially when a child is crying or active. But if a child has stridor while resting, it can be a sign of more severe croup. As your child's effort to breathe increases, she may stop eating and drinking. She also may become too tired to cough, and you may hear the stridor more with each breath.

The danger of croup with stridor is that sometimes the airway may swell so much your child may barely be able to breathe. In the most severe cases, your child will not be getting enough oxygen into her blood. If this happens, she needs to go to the hospital. Luckily, these most severe cases of croup do not occur very often.

Treatment at home

If your child wakes up in the middle of the night with croup, take him into the bathroom. Close the door and turn the shower on the hottest setting to let the bathroom steam up. Sit in the steamy bathroom with your child. Within 15 to 20 minutes, the warm, moist air should help his breathing. The barky cough may take longer to improve.

Sometimes another attack of croup will occur the same night or the next. If it does, repeat the steam treatment in the bathroom. Steam almost always works. If it does not, take your child outdoors for a few minutes. Inhaling moist, cool night air may help open the air passages so that he can breathe more freely.

When to call the doctor

If you are concerned that your child's croup is not improving, contact your child's doctor, local emergency department, or emergency medical services (911) even if it is the middle of the night. Consider calling if your child

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  Makes a whistling sound that gets louder with each breath

  
  


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  Cannot speak or make verbal sounds for lack of breath

  
  


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  Seems to be struggling to catch her breath

  
  


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  Has bluish lips or fingernails

  
  


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  Has stridor when resting

  
  


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  Drools or has extreme difficulty swallowing saliva

  
  

Treating with medicine

If your child has viral croup and is not breathing better after a steam treatment, your child's doctor or the emergency department doctor may give your child a breathing treatment with epinephrine (adrenaline) to decrease the swelling. They may also prescribe a steroid medicine to reduce the swelling. Steroids can be inhaled, taken by mouth, or given by injection. Treatment with a few doses of steroids should do no harm. For spasmodic croup, your child's doctor may recommend allergy or reflux medicines to help your child's breathing.

Antibiotics, which treat bacteria, are not helpful for treating croup because it is almost always caused by a virus, or by allergy or reflux. Cough syrups are not useful and may do harm.

Other infections

Another cause of stridor and serious breathing problems is acute supraglottitis (also called epiglottitis). This is a dangerous infection, usually caused by bacteria, with symptoms that can resemble croup. Luckily, this infection is much less common now because of the Haemophilus influenzae type b (Hib) vaccine. Rarely, supraglottitis is caused by other bacteria.

Acute supraglottitis usually affects children 2 to 5 years old and comes on suddenly with a high fever. Your child may seem very sick. He may have a muffled voice and prefer to sit upright with his neck extended and face tilted upward in a "sniffing" position to make his breathing easier. He also may drool because he cannot swallow the saliva in his mouth. If not treated, this disease could rapidly lead to complete blockage of your child's airway.

If your child's doctor suspects acute supraglottitis, your child must go to the hospital right away. If he has supraglottitis, he will need antibiotics, and he may also need a tube in his windpipe to help him breathe. Call your child's doctor right away if you think your child may have supraglottitis.

To protect against acute supraglottitis, your child should get the first dose of the Hib vaccine when he is 2 months old. This vaccine will also protect against meningitis (a swelling in the covering of the brain). Since the Hib vaccine has been available, the number of cases of acute supraglottitis and meningitis has dramatically decreased.

Recurrent or persistent croup

When croup persists or recurs frequently, it may be a sign that your child has some narrowing of the airway that is not related to an infection. This may be a problem that was present when your child was born, or one that developed later. If your child has persistent or recurrent croup, your child's doctor may refer you to a specialist for further evaluation.

Croup is a common illness during childhood. Although most cases are mild, croup can become serious and prevent your child from breathing normally. Contact your child's doctor if your child's croup is not improving or if you have other concerns. He or she will make sure your child is evaluated and treated properly.