Croup is a viral infection that afflicts mostly young children under age six. With croup, the vocal chords swell, resulting in a barking cough some compare to the sounds a seal makes. Since the vocal chords are the narrowest part of the airway, this constriction may interfere with breathing. Although croup is usually not a serious infection, the swelling may make it difficult to breathe. It is important for parents to closely monitor their child when he or she has the croup in order to make the distinction between a non-serious case of croup and a situation in which the child may need emergency medical intervention.
The duration of the croup is typically five to six days. It usually worsens at night, and the symptoms peak at about the second or third night. Croup may begin unexpectedly without warning or may develop from an innocent common cold. The virus that causes croup is just as contagious as the common cold, so frequent hand washing is a good idea to help prevent it from spreading.
The symptoms of croup include a harsh, barking cough and common cold symptoms. A fever, usually less than 104°F (40°C) can accompany it. Your child may have a hoarse voice resulting from the swelling of the vocal chords. The most important symptom to monitor is a stridor, which is the gasping, raspy sound your child makes when taking a breath in.
In a non-serious case of croup, the affected child acts normally, is happy and playful and has a decent appetite. If he or she can sleep reasonably well and has the cough, but not the stridor, then you can most likely treat your child at home, or wait until the next business day to contact your doctor for advice. If your child has a non-serious case of croup, the home treatment is fairly simple. Keep your child calm and provide him or her with lots of comfort.
Sitting in a steamy bathroom helps relieve croup symptoms, as the humidity aids in clearing breathing passages. A cool mist humidifier or vaporizer will do the trick as well. The cool night air also works wonders in clearing the airways. Many children have shown up to the emergency room (ER) with improved symptoms simply because of the midnight outing. Any fever which accompanies croup can be treated with Acetaminophen or Ibuprofen.
A case of the croup can quickly progress to something more serious. If you feel that your child's condition is worsening, call your doctor or ER for instructions. If your child is concentrating on breathing, this may signal an obstructed airway. Watch for “indrawing,” in which the child pulls in at the neck, shoulders or ribs while breathing.
If the stridor is getting worse and is bad even when the child is calm, then the croup may have become serious. Go immediately to the ER if the indrawing becomes worse and the child is obviously working hard to breathe. If he or she is pale and can’t cry or talk, or is drooling or has trouble swallowing, this is cause for great concern.
The ER staff will check your child's blood oxygen levels to see how much oxygen he or she is getting. If the croup is bad, the doctor may administer a dose of vaporized epinephrine, which works fast to open airways. Your child may also be prescribed steroids for a short period to help keep the airways open for the duration of the infection.
A child can get croup at any time of the year, although the condition is more likely to occur during the late autumn and early winter months. This may be because there are more colds and viruses around at this time of the year.
The initial symptoms of viral croup are similar to those of a cold. They include:
sore throat
runny nose
high temperature of 38°C (100.4°F) or above (in some, but not all, cases)
cough
Over one to two days, the more specific symptoms that are characteristic of croup will develop. These symptoms are:
a bark-like cough
a hoarse or croaky voice
difficulty breathing
rasping (a harsh grating sound) when breathing in, called stridor
The symptoms of spasmodic croup are similar to those mentioned above. However, a bark-like cough and stridor tend to occur suddenly (usually at night), with the child feeling well before the specific croup symptoms begin.
Stridor is often most noticeable when the child cries or coughs. However, in more severe cases of croup it can also occur when the child is resting or sleeping. For reasons that are unclear, the symptoms of croup tend to be worse at night.
Although the symptoms of croup usually only last for a few days, they can occasionally last for up to a week.
Croup is a condition that can usually be diagnosed by a GP and mild cases can usually be effectively treated at home.
However, if your child’s symptoms are severe (see below), you should take them to the nearest hospital’s accident and emergency (A&E) department or dial for an ambulance.
You should seek immediate medical attention if your child has any of the following symptoms:
severe breathing difficulties
increased breathing rate (they are too breathless to feed or talk) or 'silent chest' (you are unable to hear sounds of breathing)
worsening cough or rasping sound (stridor)
distress and agitation
the skin appearing dark, blue-tinged or pale
the skin around the ribs and chest appearing to be pulled in and tight, making the bones of the chest and ribs more visible
abnormal drowsiness and sleepiness
a high temperature of 38°C (100.4°F) or above
a rapid heartbeat or a falling heart rate
Some of these symptoms may indicate a potentially life-threatening underlying condition called epiglottitis (inflammation of the epiglottis, which is the flap of cartilage that closes off the entry to the voice box when you swallow). The symptoms could also indicate tracheitis (inflammation of the windpipe), which also requires immediate medical attention.
If your child wakes up in the middle of the night with croup, take him into the bathroom. Close the door and turn the shower on the hottest setting to let the bathroom steam up. Sit in the steamy bathroom with your child. Within 15 to 20 minutes, the warm, moist air should help his breathing. The barky cough may take longer to improve.
Sometimes another attack of croup will occur the same night or the next. If it does, repeat the steam treatment in the bathroom. Steam almost always works. If it does not, take your child outdoors for a few minutes. Inhaling moist, cool night air may help open the air passages so that he can breathe more freely.
If your child has viral croup and is not breathing better after a steam treatment, your child's doctor or the emergency department doctor may give your child a breathing treatment with epinephrine (adrenaline) to decrease the swelling. They may also prescribe a steroid medicine to reduce the swelling. Steroids can be inhaled, taken by mouth, or given by injection. Treatment with a few doses of steroids should do no harm. For spasmodic croup, your child's doctor may recommend allergy or reflux medicines to help your child's breathing.
Antibiotics, which treat bacteria, are not helpful for treating croup because it is almost always caused by a virus, or by allergy or reflux. Cough syrups are not useful and may do harm.