Croup in Children: Diagnosis and Treatment

coughing child
Young girl coughs in bed. DesignPics/Don Hammond/Getty Images

Croup (also known as acute laryngotracheobronchitis) is a viral illness that is easy to recognize—when you know what to look for. It is common in babies and toddlers and can be frightening for both children and parents. But it is usually not serious.

As you might be able to make out from its technical name, croup is an inflammation, or swelling, of the larynx (voice box), trachea (windpipe), and bronchial tubes (the passageways from the trachea into the lungs). Because small children have smaller airways, this swelling can happen more quickly and easily as the result of a viral infection.

Croup Symptoms

Children with croup usually wake up in the middle of the night with a loud cough that sounds like a barking seal. Other croup symptoms might include a fever, a hoarse voice, and a runny nose. These croup symptoms are caused by swelling and mucus buildup below the child's vocal cords.

In more severe cases, children will also have stridor, which the American Academy of Pediatrics describes as a "coarse, musical sound each time that he breathes in." If a child with croup has stridor while they are quiet and sleeping or resting, that is usually a sign that they are having a lot of trouble breathing and you should seek medical attention right away. Stridor is often confused for wheezing, but has a different sound.

The first night of croup symptoms is usually the worst. After a few days, croup symptoms begin to resemble a regular cold, with a runny nose and a more normal-sounding cough. Symptoms might be better during the day, only to return the next night, so even if your child is much better after a night of croup symptoms, you should still call your pediatrician.

Croup is contagious, but older children and adults usually just get colds when they are exposed to a young child with croup.

Croup is a mild infection in most children, but it can be severe and even life-threatening because of how it restricts the airway. If your child has a barking cough and seems like they are having trouble breathing, call your doctor or seek immediate medical attention.

Croup Diagnosis

There is no testing that is currently available for croup. Diagnosis is usually made once the typical barking cough is heard. Often the cough only happens at night, so you may want to make a recording of your child to share with your health care provider.

Although it's usually not necessary, a lateral (side) neck x-ray might show a "steeple sign." A steeple sign means that the upper part of the trachea is tapering. 

Croup Treatments

The usual first croup treatment is to take your child into the bathroom, close the door, sit on top of the closed toilet seat together, and turn on a hot shower (don't leave your child unattended around hot water). Don't touch the water, but breathe in the humid air together. As the room gets steamy, it should help to relieve your child's symptoms.

Cool air from outside may also work—for example, opening a window or sitting outside with your child wrapped in a blanket. Other treatments may include a pain and fever reducer, cough suppressants (although they will likely not be helpful), and a cool mist humidifier. Always ask your child's doctor before administering any type of medication. 

If those types of treatments aren't helping and your child is still having trouble breathing, seek medical attention. If necessary, your pediatrician might prescribe oxygen, special breathing treatments (racemic epinephrine), and/or steroids.

Causes of Croup

More than one virus can cause croup, so your child might get it more than once. Croup is most commonly caused by the parainfluenza virus type I, but other subtypes of parainfluenza, adenovirus, RSV, and influenza can also cause croup.

Allergies or reflux might also trigger spasmodic croup. Spasmodic croup is similar to the viral version, except there is no fever and children have a quicker recovery.

If your child gets croup a lot or continues to get croup after age six, you might want to have them evaluated by an ear, nose, and throat specialist (ENT, also known as an otolaryngologist).

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