From the Guidelines
Croup typically lasts for 3 to 7 days in most children. The most severe symptoms, including the characteristic barking cough and noisy breathing, usually peak around the second or third night and then gradually improve 1. During the first few days, symptoms often worsen at night and improve during the day. Most children can be managed at home with supportive care, including:
- Keeping the child calm
- Ensuring adequate hydration
- Using cool mist humidifiers to ease breathing For mild symptoms, no medication is typically needed. For moderate to severe cases, a single dose of oral dexamethasone (0.15-0.6 mg/kg) may be prescribed by a healthcare provider to reduce airway inflammation and improve symptoms within 6 hours. This steroid treatment is effective because it reduces the swelling in the upper airway caused by the viral infection that triggers croup. In rare cases where breathing is significantly compromised, emergency medical attention is necessary. Parents should seek immediate medical care if their child shows signs of breathing difficulty, including rapid breathing, retractions (visible pulling in of the chest), bluish lips, or unusual lethargy. The recent study published in Pediatrics in 2022 1 focused on reducing hospital admissions for croup, but it did not provide specific information on the duration of the illness. However, the study's findings on the effectiveness of a clinical guideline and orderset to reduce hospital admissions support the importance of proper management and treatment of croup to improve outcomes and reduce morbidity.
From the Research
Duration of Croup
The duration of croup, also known as acute laryngotracheobronchitis, is typically short-lived.
- Symptoms usually resolve within 48 hours 2, 3
- In most children, the symptoms subside quickly with resolution of the cough within two days 2
- The illness is usually self-limiting, with the majority of cases resolving without the need for hospitalization 4
- However, in some cases, croup can lead to more severe complications, such as pneumonia, respiratory failure, and arrest, although these outcomes are rare 3