Croup (medical name = Laryngotracheobronchitis) is a type of upper respiratory infection that causes a distinctive barky cough. While most cases are mild, croup can quickly become scary for parents and pediatricians alike, so here’s what you should know.
What causes it?
Viruses. Croup occurs when a virus causes swelling and inflammation of the big airway/windpipe (trachea) and vocal cords (larynx). This leads to narrowing of the airway. As children get to 3-4 years old their airways are larger and less affected by this swelling; therefore it’s less common to see croup in older children.
Think of croup like a symptom of a virus. Almost any virus can lead to croup, however the most common one is Parainfluenza.
What are the symptoms?
- Barky/croupy/seal-like cough – this is the classic finding of croup. It is a distinctive dry, harsh cough that really does sound like a dog barking or a seal
- Stridor – a high pitched raspy sound heard when a kid is inhaling
- Fever
- Runny nose, congestion
- Hoarse voice
How do we determine the severity of croup?
The degree of respiratory distress is the most important factor in determining the severity of croup. Signs of moderate to severe croup that indicate respiratory distress include:
- Retractions. Sucking in the muscles between the ribs or in the neck when the child breathes.
- Stridor at rest. If your child has stridor when they are sleeping or just sitting calmly then that tells us that the degree of swelling in their airway is significant. Stridor when they are crying or being active is not as concerning.
- Cyanosis. Blueness of the lips is very concerning.
If your child has any of the above signs then you should call us and/or seek care immediately.
How is it treated?
What you can do at home:
- Try to keep your child and yourself calm
- Put your child in a steamy shower
- Take your child outside or put them by an open window because cold air exposure can help croup symptoms
- Give them acetaminophen (Tylenol) and/or Ibuprofen to treat any fever or pain
- Offer small sips of fluids to keep your child hydrated
Medications for croup:
- Dexamethasone. This is a prescription steroid that is used to decrease the inflammation of the airway to prevent your child from struggling to breathe
- It’s important to know that the steroid does not do anything to treat the virus that caused croup in the first place. Symptoms such as fever and runny nose caused by the virus won’t be treated by the steroid
- Steroids can make your child irritable and hungry
- Steroids take about 4-6 hours to start kicking in
- Racemic epinephrine. This is a prescription breathing treatment that is usually only needed in severe cases where a child is having respiratory distress