What is croup?

How to Explain Croup to a Mom

Croup is a common viral infection that causes swelling around the vocal cords and windpipe, leading to a distinctive barking cough, noisy breathing, and sometimes difficulty breathing in young children. 1

What Causes Croup

• Croup is most commonly caused by viruses, particularly parainfluenza viruses, though other viruses like influenza can cause it too 2, 3
• It typically affects children between 6 months and 6 years of age 4
• It occurs most often during fall and winter months 4, 3
• The virus causes inflammation and swelling of the upper airway, particularly the larynx (voice box) and trachea (windpipe)

Symptoms to Watch For

• The illness usually starts like a common cold with:
  • Runny nose
  • Low-grade fever
  • Mild cough
• Then progresses to more distinctive symptoms:
  • A harsh, barking cough (often described as sounding like a seal)
  • Noisy, high-pitched breathing (stridor), especially when breathing in
  • Hoarse voice
  • Difficulty breathing in more severe cases 1, 5

What Makes Croup Different from a Cold

• The distinctive barking cough that often worsens at night
• The sudden onset of respiratory distress without other respiratory symptoms
• Stridor (noisy breathing) when your child is upset or agitated, or in more severe cases, even when resting 2

How Severe Can It Get

Croup severity ranges from mild to severe:

• Mild: Barking cough but no stridor at rest
• Moderate: Barking cough with stridor at rest and some chest wall retractions
• Severe: Barking cough, significant stridor at rest, significant retractions, and decreased air entry 1

When to Seek Medical Care

Take your child to the doctor if:

• The barking cough persists
• Your child has stridor (noisy breathing) at rest
• Your child has difficulty breathing or increased work of breathing
• Your child appears unusually tired or lethargic
• Your child has difficulty swallowing or drooling
• Your child's lips or skin develop a bluish color 1, 6

Home Management

For mild croup:

• Keep your child calm (crying can worsen symptoms)
• Sit upright or hold your child in a comfortable position
• Ensure adequate fluid intake
• Use fever-reducing medications if needed 1

Medical Treatment

If your child needs medical attention, treatments may include:

• Corticosteroids: A single dose of dexamethasone is recommended for all children with croup, even mild cases, to reduce inflammation and improve symptoms 1, 5
• Nebulized epinephrine: For moderate to severe cases to quickly reduce airway swelling 1, 6
• Oxygen: If your child's oxygen levels are low 1

Expected Course

• Most cases of croup are mild and resolve within 2-3 days 5
• The barking cough typically improves within 2 days
• Only 1-8% of children with croup require hospitalization 5
• Recurrent episodes can occur in some children 7

Prevention

• Regular handwashing
• Avoiding close contact with people who have respiratory infections
• Keeping your child's vaccinations up to date, particularly for influenza

Remember that while croup's distinctive cough can sound frightening, most cases can be managed effectively, and children typically recover completely without complications.