Croup is an infection of the upper airways that causes breathing difficulty and a “barking” cough. Croup is due to swelling around the vocal cords. It is common in infants and children. Croup affects children ages 3 months to 5 years. It can occur at any age. Some children are more likely to get croup and may get it several times. It is most common between October and April, but can occur at any time of the year. Croup is most often caused by viruses such as parainfluenza RSV, measles, adenovirus, and influenza. More severe cases of croup may be caused by bacteria. This condition is called bacterial tracheitis. Croup-like symptoms may also be caused by:

• Allergies
• Breathing in something that irritates the airway
• Acid reflux

Symptoms

The main symptom of croup is a cough that sounds like a seal barking. Most children will have mild cold and low grade fever for several days before having barking cough and a hoarse voice. As the cough gets more frequent, the child may have trouble breathing or stridor (a harsh, crowing noise made when breathing in). Croup is typically much worse at night. It often lasts 5 or 6 nights. The first night or two are most often the worst. Rarely, croup can last for weeks.

Exams and Tests

The SAMPLE history will provide clues about the patient’s condition which will lead to an examination of the patient’s chest to check for:

• Difficulty breathing in and out
• Whistling sound (wheezing)
• Decreased breath sounds
• Chest retractions with breathing

An exam of the throat may reveal a red epiglottis. In a few cases, x-rays or other tests may be needed. A neck x-ray may reveal a foreign object or narrowing of the trachea.

Treatment

Most cases of croup can be safely managed at home. Croup is minimized with the following interventions:

• Expose the child to cool or moist air, such as in a steamy bathroom or outside in the cool night air. This may offer some breathing relief.
• Set up a cool air vaporizer in the child’s bedroom and use it for a few nights.
• Make the child more comfortable by giving acetaminophen. This medicine also lowers a fever so the child will not have to breathe as hard.

The ambulance may be summoned if the following are seen by the parents

• Have breathing problems that do not go away or get worse
• Become too tired because of breathing problems
• Have bluish skin color (cyanosis)
• Are not drinking enough fluids

Medicines and treatments used at the hospital may include:

• Breathing medicines given with a nebulizer machine
• Steroid medicines given through a vein (IV)
• An oxygen tent placed over a crib
• Intravenous fluids
• Intravenous antibiotics

Outlook (Prognosis)

Croup is most often mild, but it can still be dangerous. It most often goes away in 3 to 7 days. The tissue that covers the trachea (windpipe) is called the epiglottis. If the epiglottis becomes infected, the entire windpipe can swell shut. This is a life-threatening condition. If an airway blockage is not treated promptly, the child can have severe trouble breathing or breathing may stop completely.