What is croup?

Croup is a common illness in children. It is an infection that leads to swelling of the vocal cords and windpipe (trachea). As a result of this airway swelling, breathing can become difficult. Most children may get croup once or twice, but some children can develop croup whenever they get a respiratory illness. Croup typically affects young children, from around 6 months to 6 years of age. After age 6, children usually do not develop croup because their larger airways are not as affected by swelling.

There are two types of croup:

Viral Croup is the most common type, and is caused by a viral infection that affects the airway. This usually starts with cold symptoms such as sore throat, runny nose, and nasal congestion. This turns into a barking cough (like a seal) and hoarseness, and breathing gets noisier. Some children with croup develop musical sound when they breathe in. This is called stridor.
Spasmodic croup is caused by an upper respiratory infection or allergy. This can be scary, because it often comes suddenly in the middle of the night. Your child may go to bed with mild cold symptoms, or no symptoms at all, but wake up a few hours later with hoarseness, stridor, and difficulty breathing.

What is the treatment for croup?

If your child wakes up in the middle of the night with croup, take him or her to the bathroom, turn on the hot water in the hot shower to develop a steamy mist in the bathroom. Cuddle with your child on the toilet seat. An important principle is to keep your child as calm as possible, as slow controlled breathing can reduce anxiety and reduce the severity of stridor. Sometimes bringing your child outdoors into the cool dry air can help. If these measures do not help, and your child is struggling, call your pediatrician. In rare instances, the swelling can become so severe that your child cannot effectively breathe.

If your child continues to have difficulty despite steam treatment, your pediatrician may prescribe a steroid medication to reduce airway swelling. Steroids can be inhaled, ingested, or given by injection. Antibiotics are used to treat bacteria, and does treat croup because it is a viral infection.

  • If you are concerned that your child has croup, call your pediatrician even if it in the middle of the night. Listen to your child’s breathing closely. Call 911 immediately if your child
    Makes a whistling sound that worsens with each breath
  • Cannot speak or make verbal sounds for lack of breath
  • Struggles to get a breath
  • Has bluish mouth or fingernails
  • Has stridor when resting
  • Drools or has extreme difficulty swallowing saliva

Other conditions that resemble croup:

Another infection that can lead to stridor and serious breathing problems is acute epiglottitis. This is caused by a bacterial infection. Fortunately this illness is rare due to use of vaccines for two types of bacteria, called Haemophilus influenza type b, and pneumococcus. A child with this develops sudden high fever, has to sit up to breathe, may drool, and have stridor. In these cases the child needs to go the hospital immediately for antibiotics and airway management with a tube in his or her windpipe to help breathe.

If the symptoms of croup persist or recur frequently, your child may have narrowing of the airway that is not related to infection. If this is happening, it is important to speak with your pediatrician, who might consider a referral to a specialist for further evaluation.