Croup is a common respiratory childhood illness best known for producing a distinct cough that sounds like a barking seal. Croup affects a child’s airways, including the voice box (larynx), the windpipe (trachea), and the tubes going into the lungs (bronchi).
The infection causes these airways to swell and narrow. When air is forced through a narrow passage during a cough, swollen vocal cords produce a barking cough. Similarly, taking a breath in through a narrow passage can produce a high-pitched whistling sound, called a stridor.
Croup is seen mostly in children between the ages of 6 months to 5 years, but the peak age is 2 years old. It is more common in the winter, and some children may get recurrent croup.
The most common symptoms include:
Symptoms tend to be worse at night and seem to improve in the morning but can worsen as the day goes on. Symptoms typically last between 3-7 days.
Croup can be caused by many viruses, such as respiratory syncytial virus (RSV), influenza, rhinovirus, adenovirus, and most commonly, human parainfluenza virus (HPIV). In some children, these viruses may produce mild respiratory symptoms, while in others it may cause croup. Viruses that cause croup can be spread easily from child to child by coughing or sneezing. If your child has croup, it is best to keep them away from school or daycare until their symptoms have resolved.
For mild cases of croup, home measures are appropriate in an otherwise well-appearing child. These home treatments include:
It’s always best to contact your child’s pediatrician or family medicine provider to discuss their symptoms and confirm a diagnosis.
Croup causes swelling and narrowing of airways, and young children have smaller airways. Even a small amount of swelling can cause them to have a difficult time breathing. As a result, oxygen levels in the blood can drop. Warning signs of a low oxygen level include difficulty waking up, bluish lips or face, and trouble breathing.
It is important to consult with your pediatrician as soon as possible if your child’s cough is not getting better or if they are having any difficulty breathing or show other signs of low oxygen levels. Your pediatrician or family medicine provider may prescribe an oral or injected form of steroid that can help decrease swelling of the airways and relieve some of their breathing difficulty.
For severe cases of croup where a stridor is persistent or if a child’s breathing difficulty is getting worse, we may recommend going to the emergency room for a specialized inhaled medication, oxygen supplementation, and for further monitoring.