Croup, also called laryngotracheobronchitis, is a respiratory illness that causes noisy breathing. It is associated with a distinctive barking cough that sounds like a seal’s bark. Croup usually affects babies and younger children below 3 years of age. Please continue reading to find out more about the causes, symptoms, and treatment options for croup.

What is the main cause of croup?

Croup typically occurs from a viral infection of the respiratory tract. It can be caused by viruses such as influenza, parainfluenza, adenovirus, measles, and RSV. These respiratory viral infections are common, and most children who get them don’t develop croup.

However, in some younger children, the viral infection causes the child’s voice box (larynx) and windpipe (trachea) to swell. This causes the airways to become narrow and makes breathing noisy and difficult. 

Croup is most common in children younger than 3 years of age because they have smaller airways. The swelling affects the airway, causing narrowing, which leads to a barking cough when the child breathes. In older children with larger airways, the swelling is less likely to narrow the child’s airways and cause trouble breathing.

Is croup the same as RSV?

Croup and respiratory syncytial virus (RSV) are both respiratory illnesses. Croup affects babies and young children. Respiratory syncytial virus (RSV) can affect both children and adults. RSV is a distinct viral infection that causes cold-like symptoms, including cough, sneezing, and a runny nose. RSV is one of the viruses that can cause viral croup in children.

Is croup the same as whooping cough?

No, croup is caused by a viral infection. Whooping cough (pertussis) is a bacterial infection in which there is a whooping (high-pitched or gasping) cough. There is a vaccine to prevent pertussis, and antibiotics can be used to treat it. There is no vaccine to treat croup, and antibiotics do not work against viruses. However, croup often gets better on its own. Whooping cough can be more difficult to treat.

What are croup symptoms?

The most common symptom of croup is a harsh-sounding barking cough. The child’s symptoms can also include a vibrating, raspy, or high-pitched whistling sound called stridor. Other common symptoms of croup include fever, hoarse voice, rash, conjunctivitis (pink eye), and swollen glands. In severe cases, there can be severe coughing, difficulty breathing, nervousness, restlessness, retractions (sucking in the child’s ribs), and a bluish tinge to the skin. 

Symptoms in children with croup usually start slowly with a runny or stuffy nose and a slight cough. They worsen over the next 12-48 hours when a barking cough starts. The symptoms are often worse at night.

Is croup contagious?

Croup is highly contagious because the viral infections that cause croup are contagious. The illness spreads, like many respiratory infections, by breathing droplets in the air that contain the virus from the sneezes and coughs of infected children. It also spreads through close contact with children with croup and contaminated objects and surfaces. 

If your child has croup, you should keep them home from school for at least 3 days after the symptoms start and at least 24 hours after the fever is no longer present (without fever-reducing medication).

How serious is croup?

Croup is usually a mild illness. But in some children, croup symptoms can become severe. It is very rare for a child to die from croup. However, the illness can lead to complications such as severe dehydration, pneumonia, and the need for oxygen therapy and other types of breathing treatment. 

How long does severe croup last?

Most cases of mild croup last three to seven days. Severe croup can last up to two weeks. 

How is croup diagnosed?

Your child’s provider can diagnose croup based on symptoms such as your child’s cough and a physical examination. Rarely, they may order imaging (X-rays) and laboratory tests.

What is the best thing to do for croup?

Croup treatment depends on the severity of the condition. Mild croup can usually be treated at home:

• Use a cool mist humidifier. The cool air is soothing for the irritated airways. 

• Have your child inhale steam from a hot shower. You don’t have to get under the water - just stay in the bathroom with the child while the hot water runs.

• Leave the door or window open to allow cool night air into the room. 

• Avoid smoking inside the house as this can cause irritation and worsening of your child’s cough. 

• Give your child warm, clear fluids for hydration and to loosen mucus around the vocal cords and in the airways.

• For children older than 12 months of age, you may elevate the child’s head with an extra pillow to help with croup cough. 

• Use over-the-counter medications to reduce fever, such as acetaminophen (Tylenol) or ibuprofen (Advil).

• Give over-the-counter cough medicines for relief from a child’s croup and to help the child breathe more easily. Make sure you read the label carefully for age limitations.

Sleep in the same room as your child to ensure symptoms of your child’s illness do not get worse. Measure your child’s temperature regularly. If your child develops symptoms of severe croup, such as high fever, trouble breathing, stridor, retractions, or bluish skin, stay calm and call your child’s healthcare provider immediately or seek immediate medical attention in the nearest emergency room or urgent care center. Without medical treatment, severe croup can be life-threatening. 

In severe cases of croup, healthcare providers may use humidified air or oxygen, give IV fluids, and monitor the child closely for breathing problems. They may give the child medications such as:

• Corticosteroids: These drugs help to decrease swelling in the larynx (voice box) and upper airway. Examples include dexamethasone and prednisolone.

• Nebulized epinephrine for treating croup: This helps to reduce swelling in the airways and improve symptoms. The treatment may need to be repeated every 15-20 minutes for severe symptoms. 

• A breathing tube and mechanical ventilation is rarely required for croup.

How to prevent croup?

You can prevent croup by regularly washing hands and encouraging your child to do so as well. Also, encourage your child to cover their nose and mouth when coughing or sneezing. Wash your child’s toys periodically. Keep your child away from other croup cases. If your child is sick and having croup treated, keep them at home until the child’s condition improves and they are no longer contagious.

References:

1. https://my.clevelandclinic.org/health/diseases/8277-croup