At a Glance:
- Croup is an inflammation of the trachea, larynx and bronchi
- This inflammation causes a barking cough and stridor (whistling sound while inhaling)
- Croup is most often caused by viral infection (infectious croup) but may also be due to allergies, asthma or gastroesophageal reflux (spasmodic croup)
- Episodes of croup often occur at night
- Most cases of croup are mild and may be treated at home
- If the child has difficulty breathing, a high fever, is delirious, has difficulty swallowing, or is cyanotic (pale or blue tinged due to low blood oxygen) then you should head to your nearest emergency room or call an ambulance on 000
What is Croup?
Croup is the inflammation of trachea (windpipe), the bronchi (the airways to the lungs) and the larynx (voice box), most frequently due to a viral infection. This inflammation causes the airways to narrow and prompts the production of mucus, making breathing difficult and causing a harsh, barking cough.
Croup is caused by the same group of viruses responsible for the common cold. The condition is very common in children under five years of age, but in rarer cases it may affect older children. The airways of young children are narrow and soft, so any inflammation will make breathing difficult. Due to the softness of the airways, the blockage may cause them to partially collapse, making breathing even more difficult.
As children get older their airways are strengthened, making them progressively less and less likely to contract croup. Older children and adults can become infected with the viruses that cause croup but only have the symptoms of a cold rather than croup. Croup is usually not a serious condition, but any breathing problems, especially those concerning a child should be monitored in case it becomes serious.
An episode of croup typically only lasts for a few days to a week, though the cough may last for longer. The symptoms are typically worse in the first few days and at night when it is colder. Having croup confers no immunity, so children may have multiple episodes of croup as they grow.
Symptoms of Croup
As the most common cause of croup is the viruses responsible for the common cold, the condition typically first presents with normal cold symptoms, such as:
After a few days the child will then start displaying croup symptoms. These symptoms may be worse at night and include:
- Barking Cough - this cough often first manifests at night when the air is colder. The cough may last for a few hours before calming again. The child being upset or crying may increase the severity of the cough due to added constriction in the airways.
- Noisy Breathing - breathing typically becomes strained and noisy, with either a wheeze when exhaling or a whistling noise called a “stridor” when inhaling. As with the cough, the child being upset or crying may exacerbate the noisy breathing.
- Hoarse Voice - due to inflammation in the airways and larynx, as well as irritation from coughing, the child’s voice may be hoarse or croaking.
While the cough and noisy breathing are rarely serious, monitoring croup symptoms, especially and breathing difficulties, is important, as medical care or hospitalisation should be sought if symptoms become severe.
Signs you should seek immediate medical attention for croup include:
- Difficulty Breathing - if your child is having difficulty breathing you should seek medical care. If it appears as though the child’s breastbone is caving in between breaths, or the soft tissues around their neck and between their ribs is being sucked in you should take your child to the nearest hospital emergency room, or call 000.
- Noisy Breathing At Rest - if the child’s breathing is noisy, even at rest, such as a snoring when exhaling or loud, high-pitched stridor when inhaling.
- Laboured Breathing - the effort of breathing visibly tires the child.
- High Fever - a high fever may indicate that the infection has worsened or spread. Drooling combined with a fever may indicate an obstruction in the upper airways.
- Difficulty Swallowing - inflammation of the airways may make it difficult for a child to swallow. This may cause the child to become dehydrated. If the child is drooling, it may be an indicator that their airways are obstructed.
- Cyanosis - the child becomes pale or develops a blue tinge (especially around the lips and fingernails) indicating there may be insufficient blood oxygen.
- Delirium - the child becomes restless, distressed and delirious.
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What Causes Croup?
The most common cause of croup is viral infection leading to inflammation of the larynx, trachea and bronchi. Human parainfluenza viruses (HPIV) are the most causes of croup. HPIV is broken into four types, and while all of them may cause upper and lower respiratory tract infections, only HPIV-1 and HPIV-2 can cause croup. Of the two viruses, HPIV-1 is the more common cause of the condition.
Although not every child with a cold will get croup, children with croup are still infectious and may pass a virus on to other people through droplets expelled while coughing or sneezing.
Children with asthma , some other form of respiratory illness, or allergies may experience a form of croup not caused by viral infection. This condition, known as “spasmodic croup” tends to run in families and presents without any of the symptoms that precede infectious croup, such as fever, sore throat and runny nose.
Spasmodic croup often comes on at night in the cooler air and shares the symptoms of infectious croup. While no definitive cause of spasmodic croup has been identified, an allergic reaction or gastroesophageal reflux may trigger episodes.
If your child has developed a barking cough and trouble breathing, you should immediately seek medical attention. If their breathing is OK but they have a cough that makes them sound like a seal, it’s time to book an appointment to see a doctor
Treatment for Croup
If your child isn’t experiencing breathing problems, then the croup can be cared for at home. While there isn’t a lot that can be done to cure the condition, there are a few things a parent can do to alleviate symptoms and help their child recover, such as:
- Keep the child hydrated - offering frequent, smaller drinks may be of help to children who may be experiencing some discomfort while swallowing. Staying hydrated may also soothe the throat and loosen and mucus making breathing easier.
- Keep the child calm - the symptoms of croup may worsen if the child cries or gets upset, so keeping their soothed and calm may help reduce episodes or decrease the severity of symptoms. Likewise, ensuring they get plenty of rest and don’t exert themselves too much may help reduce the severity of symptoms.
- Non-steroidal anti inflammatory drugs (NSAIDS) - child paracetamol or ibuprofen may be used to help reduce fever and discomfort.
- Cold water vapour - there is some disagreement as to the efficacy of humidifiers to aid in the easing of croup symptoms, cold water vaporisers or misters may help soothe inflamed airways. According to Harvard Medical School, cold water vapour appears to be especially effective in helping alleviate spasmodic croup.
If your child is experiencing any difficulty breathing, a doctor may prescribe some drug treatments to open the airways. These croup treatments typically include:
- Corticosteroids - steroidal medications may be prescribed to reduce inflammation in the airways. Depending on the age of the child and the severity of the constriction, the corticosteroids may be injected, in tablet form or inhaled through a nebuliser.
- Adrenaline - In some severe cases, the child may be given oxygen and nebulised adrenaline to help reduce inflammation while the corticosteroids take effect.
Other treatments may be needed for high fevers and other associated symptoms.
There is no way to immunise a child against croup, but there are some things a parent can do to reduce the risk of a child contracting a virus, such as:
- Teach them hand hygiene - if your child is old enough, teaching them how to properly wash their hands may help reduce the chance of them contracting viruses from surfaces. Ensuring that you wash your hands thoroughly and often also reduces the risk of you passing any infection to the child.
- Vaccinations - there may be no vaccine available for parainfluenza viruses, but there is a vaccine for influenza. Not only is an influenza infection potentially dangerous by itself, it may also lead to influenza-induced croup.