Croup in Children
Symptoms of Croup
- Shrill, wheezing inhalations
- A harsh, barking cough (sometimes described as "seal-like") that often occurs in sudden and spasmodic bouts
- Fever (usually less than 102 degrees F, though some children will not have any fever
- Symptoms typically appear or worsen late at night and may continue for several consecutive nights.
What Is Croup?
Because its symptoms involve breathing, croup is one of the most upsetting illnesses of childhoodbut most cases are relatively mild and do not cause any lasting damage. It's an inflammation of the area just below the voice box that causes swelling of the air passages and difficulty breathing.
Croup most commonly affects children younger than three or four years of age, waking them in the middle of the night with rasping breaths and a barking cough. It can affect children as young as three months or as old as six years.
Most cases can be safely and effectively managed at home, and symptoms usually subside within three to seven days. Some children are prone to recurring bouts of croup and seem to get it with any respiratory illness.
What Causes Croup?
Croup is usually caused by one of several viruses, which are spread from child to child, usually during the fall or winter months. Typically, a child will be sick for a day or two with a cold or a flulike illness before excessive secretions and swelling in the child’s small airways lead to labored breathing and the characteristic barking cough.
In other cases, symptoms come on very suddenly, perhaps in response to an allergy. In general, the younger the child, the more severe the symptoms. By age seven, children’s respiratory tracts are usually large enough so that croup is uncommon.
What If You Do Nothing for Croup?
Symptoms of croup should be monitored closely; although croup rarely is serious, it can become severe and lead to potentially life-threatening airway obstruction.
Home Remedies for Croup
Even though the harsh and troubled breathing may be upsetting to both parents and child, croup is almost always easily treated at home.
- Comfort your child. It's important that you and your child stay calm. Agitation and crying can make symptoms worse. Your child may prefer to sit up or lie downwhichever position makes it easier for the child to breathe and relax should be encouraged.
- Soothe the throat with warm mist. Run the bathroom faucets and shower with hot water to create a steam room effect. Keep the child in the bathroom for 20 minutes or so, perhaps by reading to him or her, until breathing becomes easier. Don't place the child over a steaming teapot or hot-steam vaporizer because of the risk of accidental burns.
- If heat does not provide relief, try cool air. Use a cool-mist vaporizer or open the bedroom windows and let the child breathe cool air. This sometimes provides relief if heat does not work. Many parents have found their child’s breathing was improved after a nighttime car ride to the emergency room. The moist night air streaming through the open windows seems to break the cycle of labored breathing.
- Keep the bedroom moist. Run a cool-mist vaporizer in the bedroom for several days, until the cough and other symptoms subside. If you don’t have a vaporizer, try hanging damp sheets or towels in the room to help keep it moist.
- Reduce fever. Acetaminophen is effective for reducing fever.
- Drink plenty of clear fluids. Encourage your child to drink plenty of water, tea, ginger ale, apple juice, or other clear liquids to prevent dehydration and to help moisten the throat and loosen mucus. Avoid milk, since it can thicken the mucus, so coughing it up becomes harder.
Prevention of Croup
Little can be done to prevent croup. The viral infections that cause it are easily transmitted from one person to the next. Avoiding contact with infected children will help to minimize your child's chances of contracting croup, although most children who get viral respiratory infections don’t get croup.
Children who are prone to recurrent bouts of croup may benefit from the use of a cool-mist vaporizer whenever they have a respiratory infection. These children will eventually outgrow it, usually by age seven.
When to Call Your Doctor for Croup
Call your doctor if:
- your child continues to have trouble breathing for more than an hour, despite use of home treatments
- breathing is rapid (more than 60 breaths a minute) or heart rate fast (more than 160 beats a minute)
- fever exceeds 102˚F
You should take your child to the emergency room if any of the following are present:
- your child is gasping for breath and seems exhausted
- your child has pale skin, blue or gray lips, or blueness around the fingernails
- your child maintains a position with the head tilted forward and the jaw jutting out and appears to be working hard to breathe
- your child has great difficulty swallowing or is drooling because it is too difficult to swallow saliva
These may be signs of airway obstruction, perhaps brought on by a serious disorder called epiglottitis. Immediate medical attention is required. However, epiglottitis, which is caused by infection with a bacterium (Hemophilus influenzae type B), is becoming increasingly uncommon since the introduction of an HiB vaccine.
What Your Doctor Will Do for Croup
In severe cases of croup, a child will be admitted to the hospital and placed in a mist tent, which makes breathing easier. The child may also receive inhaled drugs, such as epinephrine and corticosteroids, to reduce inflammation and spasm. A tube may be placed down the mouth or nose to aid breathing. If croup is complicated by a bacterial infection, the doctor will prescribe antibiotics. X-rays of the neck may be taken if the doctor suspects the child may have epiglottitis.
For More Information about Croup
- American Academy of Pediatrics
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media