Symptoms of Croup
Croup is characterized by a sudden onset of a distinctive barking cough, inspiratory stridor, hoarse voice, and respiratory distress resulting from upper airway obstruction. 1, 2
Primary Symptoms
- Barking cough: Often described as "seal-like" or "dog-like" bark, this is the most distinctive symptom 3
- Stridor: Harsh, high-pitched sound during inspiration, may worsen with agitation or crying 2
- Hoarse voice: Changes in vocal quality due to laryngeal inflammation 3
- Respiratory distress: Varying degrees of breathing difficulty 2
Progression and Associated Symptoms
Croup typically follows a predictable pattern:
- Initial phase: Symptoms often begin like an upper respiratory infection with:
- Low-grade fever
- Coryza (runny nose)
- Mild cough 3
- Progressive phase:
- Development of the characteristic barking cough
- Inspiratory stridor (initially only when agitated, later at rest)
- Increased work of breathing 1
Severity Assessment
Symptoms can be classified by severity:
Mild Croup
- Barking cough
- No audible stridor at rest
- Minimal or no respiratory distress 2
Moderate Croup
- Barking cough
- Audible stridor at rest
- Mild to moderate respiratory distress with retractions 2
Severe Croup
- Prominent inspiratory and expiratory stridor
- Significant respiratory distress with marked retractions
- Agitation or lethargy
- Decreased air entry
- Possible cyanosis or oxygen saturation <92% 2
Timing and Duration
- Symptoms typically worsen at night
- Most cases show improvement within 48 hours
- The barking cough usually resolves within 2 days 3
Distinguishing Features from Other Conditions
It's important to differentiate croup from other serious conditions:
- Unlike epiglottitis: Croup has a gradual onset rather than rapid progression, and patients typically don't have dysphagia or drooling 1
- Unlike foreign body aspiration: Croup has a viral prodrome and fever, rather than sudden onset without fever 1
- Unlike bacterial tracheitis: Croup typically has milder symptoms and responds to steroids 3
Common Pitfalls in Symptom Recognition
- Mistaking croup for asthma or bronchiolitis (croup affects upper airway, not lower)
- Failing to recognize progression from mild to severe symptoms
- Confusing croup with other causes of stridor such as epiglottitis (which presents with more toxic appearance, drooling, and inability to swallow) 2
Croup is most common in children 6 months to 6 years of age, with peak incidence in the second year of life, and typically presents in late fall or early winter 4, 3. While most cases are mild and self-limiting, recognition of progressive symptoms is crucial as severe cases may require immediate medical intervention.