Croup

Definition

Croup is breathing difficulty and a "barking" cough. Croup is due to swelling around the vocal cords. It is common in infants and children.

Alternative Names

Viral croup; Laryngotracheobronchitis - acute; Spasmodic croup; Barking cough - croup

Causes

Croup is most often caused by viruses such as parainfluenza RSV, measles, adenovirus, and influenza. It tends to appear in children between 3 months and 5 years old, but it can happen at any age. Some children are more likely to get croup and may get it several times. It is most common between October and March, but can occur at any time of the year.

More severe cases of croup may be caused by bacteria. This condition is called bacterial tracheitis.

Croup may also be caused by:

Symptoms

The main symptom of croup is a cough that sounds like a seal barking.

Most children will have mild cold symptoms for several days before the barking cough becomes evident. 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. Talk to your child's health care provider if croup lasts longer than a week or comes back often.

Exams and Tests

Children with croup are most often diagnosed based on the parent's description of the symptoms and a physical exam. Sometimes a provider will listen to a child cough over the phone to identify croup. In a few cases, x-rays or other tests may be needed.

A physical exam may show chest retractions with breathing. When listening to the child's chest through a stethoscope, the health care provider may hear:

An exam of the throat may reveal a red epiglottis. 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. However, you should call your provider for advice, even in the middle of the night.

Steps you can take at home include:

Your provider may prescribe medicines, such as:

Your child may need to be treated in the emergency room or to stay in the hospital if they:

Medicines and treatments used at the hospital may include:

Rarely, a breathing tube through the nose or mouth will be needed to help your child breathe.

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.

When to Contact a Medical Professional

Most croup can be safely managed at home with telephone support from your provider. Call your provider if your child is not responding to home treatment or is acting more irritable.

Call 911 if:

Prevention

Wash your hands frequently and avoid close contact with people who have a respiratory infection.

Many cases of croup can be prevented with immunizations. The diphtheria, Haemophilus influenzae (Hib), and measles vaccines protect children from some of the most dangerous forms of croup.

References

Bower J, McBride JT. Croup in children (acute laryngotracheobronchitis). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 61.

Cukor J, Manno M. Pediatric respiratory emergencies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 168.

Roosevelt, GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 385.