Croup is a viral infection of the vocal cords and the trachea (windpipe). The infection results in the swelling and narrowing of the upper airway, making it difficult for air to pass through. It is characterized by harsh, barking cough, hoarseness, and high-pitched noise when breathing in (1).
Croup infection usually affects young children. The symptoms are generally mild and can be treated at home. However, severe and prolonged croup infections can cause breathing difficulties in children and sometimes warrant hospitalization (1) (2).
This post discusses the causes, symptoms, risk factors, and treatment options for croup in children.
What Causes Croup In Children?
Croup is commonly caused by the human parainfluenza virus (types 1 and 3). However, influenza A and B viruses, respiratory syncytial virus, rhinovirus, coronavirus, human metapneumovirus, and adenovirus may also cause croup infection.
Viral croup is the second most common cause of respiratory distress in children below ten years, and the viral infection affects boys more than girls (3).
Symptoms Of Croup In Children
Croup generally begins with cold-like symptoms, such as a runny nose, fever, and cough. The following symptoms are observed after 24–72 hours of infection. The symptoms seem to worsen during the night and fluctuate, depending on whether the child is calm or agitated (1) (3).
The main symptoms include:
- Harsh coughing, which often sounds like barking
- Noisy breathing with a high-pitched, squeaky sound, known as stridor
The symptoms can be categorized based on the level of severity.
- Occasional barky cough
- Stridor while sleeping or not present at all
- Mild indrawing of area above neck called supraclavicular area
- Frequent barky cough
- Easily audible stridor during sleep
- Limited or no distress
- Visible indrawing of supraclavicular area
- Frequent barky cough
- Prominent stridor during inhalation and occasional stridor while exhaling
- Noticeable distress or agitation
- Severe indrawing of supraclavicular area
- Can lead to complete obstruction of airways and failure of breathing, if not treated in timeSevere indrawing of supraclavicular area
- Can lead to complete obstruction of airways and failure of breathing, if not treated in time
Other symptoms include
- Sneezing and a runny nose
- Hoarse voice
- Red eyes
- Poor appetite
The symptoms are short-lived. Approximately 60% of children experience a reduction of barky cough by 48 hours or less, and only in about less than 2% of children, the cough might persist for more than five nights (3).
Who Are At Risk Of Contracting Croup?
The risk of contracting croup infection increases based on the age of the child and specific seasons. It is commonly seen in children between six months and three years. However, it can occur in children up to six years of age. Croup infections occur in a predictable pattern, with the infections seen in late fall and winter.
Recurrent croup infections (more than two episodes per year) are found in children who
- Had prior intubations.
- Are premature.
- Are younger than three years.
Is Croup Contagious?
Yes, croup can spread from one child to another through respiratory droplets when children with croup cough or sneeze. It also spreads when a healthy child touches their face, nose, or eyes after coming into contact with contaminated surfaces, such as doorknobs.
Physical examination and pediatric history are the two diagnostic methods to detect croup in children. In some rare cases, such as when the child is asymptomatic or when the diagnosis is unclear, the doctor might recommend radiography or laryngoscopy (3) (4).
Treatment For Croup In Children
Mild to moderate croup infection can be treated at home with oral corticosteroids and nebulized epinephrine. Severe cases require hospitalization. These medications help in minimizing the symptoms by reducing the swelling of the child’s airway. The cough may not reduce, but stridor and inward drawing of chest walls may subside (4).
When your child experiences no stridor or chest wall indrawing at rest, they may go home (if the child is hospitalized). However, your doctor is the best person to estimate your child’s condition.
Home-Care Tips For Croup In Children
If your child has a mild infection, you may follow the below home-care tips to relieve the symptoms (3).
- Try not to agitate or upset your child, as distress can worsen the stridor and other symptoms.
- If your child is crying, place them on your lap in a comfortable position.
- Give them fluids to soothe their sore throat.
- Ask them to take plenty of rest.
- Avoid using humidifiers as they are found to be ineffective in the treatment of croup.
- You can give them acetaminophen (paracetamol) but only after consulting your doctor.
When To See The Doctor?
- Fatigue or lethargy
- Decreased levels of consciousness
- Trouble breathing
- Body turning blue or pale due to lack of oxygen
- Sudden high temperature
- Difficulty swallowing
- Inability to speak
Prevention Of Croup
You can protect your child from croup infection or prevent your child from infecting someone by taking the following precautions.
- Make sure they wash their hands before eating and after coming home from school or the playground.
- Instruct them not to touch their face, nose, or eyes before washing hands.
- If someone has croup, ask your child to maintain physical distance until they get well.
- Keep your child’s vaccinations up to date.
- Give them nutritious foods that can help boost their immunity.
- Encourage them to cover their nose and mouth while coughing and sneezing.
Adults may rarely get infected. However, it is best to be careful while taking care of your child. As the infection is contagious, do not send your child to school until the symptoms subside or for at least three days.
Croup is a common viral infection in children that goes away in a week or two. Make sure you give your child plenty of rest and liquids. If the symptoms worsen or your child has difficulty breathing, it is best to consult your pediatrician.
2. Croup; NHS
3. Candice L. Bjornson and David W. Johnson; Croup in children; CMAJ (2013).
4. Dustin K. Smith, Andrew J. McDermott, and John F. Sullivan; Croup: Diagnosis and Management; American Family Physician (2018).
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