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Croup

Definition

Croup is breathing difficulty and a "barking" cough. Croup is due to swelling around the vocal cords. It is common in infants and children.

Alternative Names

Viral croup; Laryngotracheobronchitis - acute; Spasmodic croup

Causes

Croup is most often caused by viruses, such as parainfluenza RSV, measles, adenovirus, and influenza. It tends to appear in children between 3 months and 5 years old, but it can happen at any age. Some children are more likely to get croup and may get it several times. It is most common between October and March, but can occur at any time of the year.

More severe cases of croup may be caused by bacteria. This condition is called bacterial tracheitis.

Croup may also be caused by:

  • Allergies
  • Breathing in something that irritates your airway
  • Acid reflux

Symptoms

The main symptom of croup is a cough that sounds like a seal barking.

Most children will have mild cold symptoms for several days before the barking cough becomes evident. As the cough gets more frequent, the child may have trouble breathing or stridor (a harsh, crowing noise made when breathing in).

Croup is typically much worse at night. It often lasts 5 or 6 nights. The first night or two are most often the worst. Rarely, croup can last for weeks. Talk to your child's doctor if croup lasts longer than a week or comes back often.

Exams and Tests

Children with croup are most often diagnosed based on the parent's description of the symptoms and a physical exam. Sometimes a doctor will listen to a child cough over the phone to identify croup. In a few cases, x-rays or other tests may be needed.

A physical exam may show chest retractions with breathing. When listening to the child’s chest through a stethoscope, the health care provider may hear:

  • Difficulty breathing in and out
  • Wheezing
  • Decreased breath sounds

An exam of the throat may reveal a red epiglottis. A neck x-ray may reveal a foreign object or narrowing of the trachea.

Treatment

Most cases of croup can be safely managed at home. However, you should call your health care provider for advice, even in the middle of the night.

Steps you can take at home include:

  • Expose your child to cool or moist air, such as in a steamy bathroom or outside in the cool night air. This may offer some breathing relief.
  • Set up a cool air vaporizer in the child's bedroom and use it for a few nights.
  • Make your child more comfortable by giving acetaminophen. This medicine also lowers a fever so the child will not have to breathe as hard.
  • Avoid cough medicines unless you discuss them with your doctor first.

Your health care provider may prescribe medicines, such as:

  • Steroid medicines taken by mouth or through an inhaler
  • Antibiotic medicine (for some, but not most cases)

Your child may need to be treated in the emergency room or to stay in the hospital if he or she:

  • Has breathing problems that do not go away or get worse
  • Becomes too tired because of problems breathing
  • Has bluish skin color
  • Is not drinking enough fluids 

Medicines and treatments used at the hospital may include:

  • Breathing medicines given with a nebulizer machine
  • Steroid medicines given through a vein (IV)
  • An oxygen tent placed over a crib
  • Fluids given through a vein for dehydration
  • Antibiotics given through a vein

Rarely, a breathing tube through the nose or mouth will be needed to help your child breathe.

Outlook (Prognosis)

Croup is most often mild, but it can still be dangerous. It usually goes away in 3 to 7 days.

The tissue that covers the trachea (windpipe) is called the epiglottis. If the epiglottis becomes infected, the entire windpipe can swell shut. This is a life-threatening disease.

If an airway blockage is not treated promptly, the child can have severe trouble breathing or breathing may stop completely.

When to Contact a Medical Professional

Most croup can be safely managed at home with telephone support from your health care provider. Call your provider if your child is not responding to home treatment or is acting more irritable.

Call 911 if:

  • Croup symptoms may have been caused by an insect sting or inhaled object
  • Your child has bluish lips or skin color
  • Your child is drooling 
  • Your child is having trouble swallowing
  • There is stridor (a noise when breathing in)
  • There is a tugging-in of the muscles between the ribs when breathing in
  • Your child is struggling to breathe

Prevention

Wash your hands frequently and avoid close contact with people who have a respiratory infection.

Many cases of croup can be prevented with immunizations. The diphtheria, Haemophilus influenzae (Hib), and measles vaccines protect children from some of the most dangerous forms of croup.

References

Hall CB, McBride JT. Acute laryngotracheobronchitis (croup). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009:chap 56.

Everard ML. Acute bronchiolitis and croup. Pediatr Clin North Am. 2009;56(1):119-133.

Roosevelt GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 377.


Review Date: 5/14/2014
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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