Overview

What is croup?

Croup (laryngotracheobronchitis) is a common upper airway tract infection in babies and young children. It affects children between the ages of 3 months and 5 years, with peak incidence for children aged 2 years. The condition causes swelling and redness in the trachea (the windpipe), the larynx (the voice box) and the bronchi, which leads to symptoms including a distinctive barking cough and whistling sound while breathing (strider). Croup is highly contagious but usually mild, rarely it can become severe affecting the child’s ability to breathe and requiring hospitalization. It is most commonly caused by a virus, and rarely caused by bacteria or allergies. The most common viruses that cause croup are: parainfluenza virus, influenzas virus, respiratory syncytial virus (RCV), adenovirus, and enterovirus.¹

The viruses that cause croup can spread through the air so if someone with croup coughed or sneezed next to your child, the air droplets your child breathes can contain the viruses that cause the disease. Touching objects contaminated with the viruses can also be a way to acquire the condition.

Symptoms and diagnosis

Croup usually starts mild as a common cold, with a sore throat, a runny nose, and a fever. The inflammation worsens after a day or two and new symptoms appear, a very characteristic cough that sounds like a barking dog. And in some severe cases respiratory stridor, a loud whistling sound that can be heard when the child breaths in or out. The symptoms of croup are worse at night and can get better during the day. The diagnosis in most of the cases is made clinically based on signs and symptoms and the characteristic cough. Rarely a swab can be taken to confirm the viral infection. X-ray of the neck can exclude other conditions, but this is also hardly necessary due to its typical clinical presentation.²

Treatment and management of croup

Management/treatment of croup depends on the severity of the condition. The severity of croup can vary depending on your child’s age, medical history and overall health. A history of previous respiratory conditions can worsen the case. The treatment can be different for mild/moderate and severe cases.³

Mild croup

Mild cases of croup can be treated at home. There are few things you can do for your child to help ease the symptoms such as:

• Use a cool air humidifier to sooth the airway
• Sit with your child in a bathroom filled with steam, but be careful to not let your child get in the hot water
• Treat the fever with over-the-counter medications
• Give your child warm fluids to help with coughing and clear the airway
• Avoid smoking as it can worsen the cough
• Keep their head elevated with a pillow (avoid doing that with infants younger than 12 months)
• Sleep in the same room with your child to monitor their breathing and airway

Moderate to severe croup

If the home treatment options didn’t work and your child has started having difficulty breathing, take them to the nearest urgent care facility or emergency room. Based on the severity of the symptoms, the treatment options can include the following:

• Oxygen or humidifier air
• Your child can be given IV fluids for dehydration
• Croup medications, glucocorticoids and nebulized breathing treatment(epinephrine)
• Mechanical ventilation can be placed in very rare severe cases

Glucocorticoids

Glucocorticoids, most often prednisolone or dexamethasone, work for croup by decreasing the swelling and inflammation of the larynx. They reduce the symptoms as fast as two hours after taking them, shorten the hospital stay, and reduce the need for return or hospital readmission.⁴ One dose is usually given orally, but in case of vomiting, they can be delivered through intravenous or intramuscular route.

Nebulized breathing treatment/epinephrine

Epinephrine also known as adrenaline can be given as an inhaled mist to decrease the swelling of your child’s larynx and trachea. Inhaled epinephrine can reduce the symptoms of croup after 10 to 30 minutes of administering the dose. The effect wears off after two hours, however the symptoms will not worsen after that.⁵

Prevention

Croup spreads through air and by touching contaminated objects. You can help prevent spread of the disease by following these tips:

• Wash your hands regularly, and teach your kids how to wash their hands properly
• Teach your child to cover their nose and mouth when coughing and sneezing
• Keep your child at home if they are not feeling well, and don’t send them back to school or daycare unless they are feeling better
• Advise your child to not share cups and utensils with other children

FAQ’s

How can I tell if my child has croup?

You can rely on signs and symptoms. The most common symptoms are barking cough and stridor. The condition is also more common during fall and winter time.

When should I worry about croup?

If your child is showing symptoms of distress or difficulty in breathing, take them to the nearest ER.

When can my child go back to school?

Your child can be contagious until his/her symptoms disappear, or until after 24 hours of the last time they had a fever.

How long does croup last?

In most cases it lasts from 3 to 4 days, but it can last for as long as one week.

Should I let my child with croup sleep?

Yes, allowing your child to rest can help fight the viral infection faster, but it is better to sleep next to them to keep an eye and to monitor any signs of respiratory distress.

Summary

Croup, a common respiratory condition in children, is characterized by a barking cough, hoarseness, and sometimes difficulty breathing due to inflammation of the upper airway. Treatment aims to ease symptoms and prevent complications. Home remedies such as humidifiers, steam therapy, and maintaining hydration can provide relief. Additionally, corticosteroids are often prescribed to reduce airway inflammation. In severe cases, hospital-based treatments such as nebulized epinephrine, oxygen therapy and intravenous fluids may be necessary. Prompt medical attention should be sought if symptoms worsen or if there are signs of respiratory distress. Overall, timely intervention and preventive measures play crucial roles in managing croup effectively in children.