It's the middle of the night. Your child wakes up with a strange, barking cough you've never heard before. Their voice is hoarse, and you hear a harsh sound when they breathe in. What is this?
Chances are your child has croup - also called laryngotracheitis. It sounds frightening, but most cases are mild and can be managed safely at home. Here's a clear overview of what croup is, what you can do, and when to contact a doctor.
What Is Croup?
Croup is a viral infection that causes swelling in the mucous membranes around the voice box and windpipe. The swelling narrows the airways, which creates the characteristic barking cough and harsh breathing sound.
The condition most commonly affects children between 6 months and 6 years. This is because young children have narrower airways than older children and adults. Even slight swelling can make it noticeably harder to breathe.
Croup is most common in fall and winter, and is usually triggered by the same viruses that cause colds - parainfluenza virus is the most frequent cause.
Croup vs. Epiglottitis
Croup is completely different from epiglottitis, which is a rare but serious bacterial infection of the epiglottis. Epiglottitis causes high fever, drooling, difficulty swallowing, and the child leaning forward to breathe. Epiglottitis is acute and life-threatening - call 911 immediately if you suspect it.
Symptoms of Croup
Croup typically starts with common cold symptoms - runny nose, mild fever, and a slight cough. After a day or two, the picture changes, often suddenly at night.
Typical croup symptoms:
- Barking cough - a dry, seal-like cough that sounds like a dog barking. Completely unlike a regular cough.
- Hoarseness - the voice becomes hoarse and rough because the vocal cords are swollen.
- Stridor - a harsh, wheezing sound when the child breathes in. This is caused by air being forced through the narrow, swollen airways.
- Worsening at night - symptoms are almost always worst at night and early morning.
Stridor that only occurs when the child is crying or upset suggests mild croup. Stridor at rest - when the child is sitting still - is a sign that the airways are significantly narrower, and the child should be evaluated by a doctor.
Course of Illness
Croup typically lasts three to five days. The barking cough and stridor are worst the first two to three nights, then gradually improve. Some children have only one night of symptoms, while others have croup that comes and goes over several nights.
A mild cough and hoarseness can persist for up to a week after the worst symptoms have resolved.
How to Treat Croup at Home
Most children with croup have mild symptoms that can be managed at home. Here are the most important measures.
Stay Calm
Crying and agitation make symptoms worse because the child breathes faster and harder through already narrow airways. Hold the child on your lap, comfort them, and speak calmly. A calm parent means a calmer child.
Sit upright with the child on your lap instead of laying them down. An upright position makes it easier to breathe through swollen airways.
Cool, Fresh Air
Cool air can relieve the swelling in the airways. Open a window and let the child breathe in the cool air for a few minutes. Some parents take the child outside on the porch or balcony (well-wrapped in a blanket or jacket). Many find this provides rapid improvement.
Fluids
Give the child regular fluids in small sips. Breast milk, water, or diluted juice work well. Don't force the child to drink large amounts at once - small, frequent sips are best.
What About Steam from a Hot Shower?
Many have heard that steam from a hot shower helps with croup. Research shows that humid air probably has no documented effect on croup symptoms. It's still safe to try if the child finds it comfortable - it can at least be soothing.
Fever Reducers as Needed
If the child has a fever and is uncomfortable, you can give acetaminophen (Tylenol) in the correct dose for the child's weight and age.
When Should You Contact a Doctor?
Most cases of croup are mild and resolve on their own. But sometimes the child needs medical help.
Call your doctor or go to urgent care if the child has: - Stridor (harsh breathing sound) at rest - not just when crying - Clearly labored breathing with retractions in the chest - Difficulty swallowing or excessive drooling - Restless and hard to comfort - Symptoms don't improve after 30 minutes of cool air and rest - Fever above 103.1 °F (39.5 °C)
Call 911 immediately if the child:
- Turns blue around the lips or face
- Becomes very limp or stops responding to you
- Has severe breathing difficulties - you can see the child using all their strength to breathe
- You suspect epiglottitis (high fever, drooling, leaning forward, unable to swallow)
Trust your gut feeling. If you're unsure, it's always right to call.
Treatment by a Doctor
If the child needs medical treatment, doctors have several effective tools.
Steroids (Dexamethasone or Budesonide)
Steroids reduce airway swelling and are the first choice for moderate to severe croup. Dexamethasone is usually given as a single dose (tablets, liquid, or injection). The effect is noticeable within two to four hours and lasts 24 to 48 hours.
Budesonide can be given as nebulized inhalation. Both medications are safe and effective.
Epinephrine Nebulization
For severe croup with significant stridor and breathing difficulties, the doctor may give nebulized epinephrine. The epinephrine constricts blood vessels in the mucous membrane, which rapidly reduces swelling. The effect comes within minutes.
The effect of nebulized epinephrine lasts only one to two hours. The child should therefore be observed at the clinic or hospital for at least two hours after treatment, in case symptoms return.
Hospital Admission
Most children with croup don't need hospital admission. But if the child has severe breathing difficulties that don't improve with steroids and epinephrine, observation and treatment in hospital may be necessary.
Can Croup Be Prevented?
Croup is caused by common viruses, and there is no vaccine against it. But you can reduce the risk with the same measures that prevent colds.
Preventive measures:
- Good hand hygiene - wash hands often with soap and water
- Avoid close contact with people who have colds
- Keep your child home when they're sick
- Ventilate your home well
Children who have had croup once have a somewhat higher risk of getting it again. Most outgrow it by age six to seven, as the airways become roomier with age.
Common Questions
Can a child get croup multiple times?
Yes. Some children are more susceptible and can get croup several times during the toddler years. If the child has had repeated croup episodes (more than two to three times), the doctor should evaluate whether there may be other causes for the narrow airways.
Is croup contagious?
The virus that causes croup is contagious, but not all children who are infected get croup. Some just get regular cold symptoms. It depends on the child's age and the size of their airways.
How long should the child stay home?
The child should stay home until they are fever-free and feeling well. The barking cough may persist for a few days after the child is otherwise healthy. Check your daycare's guidelines.
Does cough syrup help with croup?
No. Cough syrup and cough suppressants have no documented effect on croup and are not recommended for young children. Cool air, calm, and an upright position are the best home remedies.
Can adults get croup?
Adults can be infected by the same viruses but rarely get croup because their airways are large enough to tolerate the swelling. Adults usually just get cold symptoms or hoarseness.
Read also: Baby Cough Types and Remedies | Asthma in Children - Early Signs