McFarland Clinic

FAQ about Croup

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December 10, 2013

'Tis the season for colds, coughs and sore throats. Many doctors’ offices have seen an uptick in cases of croup.  Terri Hannan, PA-C answers common questions about croup. 

What is croup?

Croup is a condition that causes an inflammation of the upper airways — the voice box (larynx) and windpipe (trachea). There is a delicate membrane along the airway which swells, decreasing the smooth flow of air into the lungs

Swelling and inflammation of the airway often leads to a barking cough or hoarseness, especially when a child cries.

Most cases of viral croup are mild and can be treated at home. Rarely, croup can be severe.

Who is most likely to get croup?

Croup is much more common in a young child because their airways are smaller.

An adult’s windpipe is only a fraction of an inch wide — about 10 to 14 millimeters. But a 2-year-old’s is even smaller: typically, just four millimeters.  

What causes croup?

Most cases of croup are caused by viruses, usually parainfluenza virus and sometimes adenovirus or respiratory syncytial virus (RSV).

Viral croup is most common — and symptoms are most severe — in children 6 months to 3 years old, but can affect older kids too. Some children are more prone to developing croup when they get a viral upper respiratory infection.

What are the symptoms?

At first, a child may have cold symptoms, like a stuffy or runny nose and a fever. As the upper airway (the lining of the windpipe and the voice box) becomes more inflamed and swollen, the child may become hoarse, with a harsh, barking cough. This loud cough, which is characteristic of croup, often sounds like the barking of a dog or seal.

If the upper airway continues to swell, it becomes even more difficult for a child to breathe, and you may hear a high-pitched or squeaking noise during inhalation (called stridor). A child also might breathe very fast or have retractions (when the skin between the ribs pulls in during breathing). In the most serious cases, a child may appear pale or have a bluish color around the mouth due to a lack of oxygen.

Symptoms of croup are often worse at night and when children are upset or crying. Besides the effects on the upper airway, the viruses that cause croup can cause inflammation farther down the airway and affect the bronchi (large breathing tubes that connect to the windpipe).

Is croup contagious?

Outbreaks of croup tend to occur in the fall and early winter when the viruses that cause it peak. Many children who come in contact with the viruses that cause croup will not get croup, but will instead have symptoms of a common cold.

Is croup serious?

Croup symptoms generally peak 2 to 3 days after the symptoms of the viral infection begin. Viral croup usually lasts 3 to 7 days.  The first 2-3 days are the worst with typical cold symptoms lingering for a few days longer.

The vast majority of children recover from croup with no complications. Rarely, a child can develop a bacterial infection of the upper airway, or pneumonia. Dehydration may follow inadequate fluid intake

Does my child need to see a doctor for croup?

Your health care professional can usually diagnose croup by listening for the telltale barking cough and stridor. They will also ask if your child has had any recent illnesses with a fever, runny nose, and congestion, and if your child has a history of croup or upper airway problems. 

 In more severe cases with slow response to treatment, a neck x-ray or chest x-ray may be ordered to rule out more serious disease. 

Immediately call your health care provider or get medical attention if your child has:

  • Difficulty breathing, including rapid or labored breathing
  • Retractions: when the skin between the ribs pulls in with each breath
  • Stridor: high-pitched or squeaking noise when inhaling
  • A pale or bluish color around the mouth
  • Drooling or difficulty swallowing
  • A fatigued appearance
  • Signs of dehydration (including a dry, or sticky mouth, few or no tears, sunken eyes, thirst, no urine or only a little dark yellow urine for 8-12 hours, extreme tiredness)
  • A very sick appearance

How is it treated?

Most, though not all, cases of viral croup are mild. Breathing in moist air helps most kids feel better, and ibuprofen or acetaminophen (only in children over 6 months old) can make them more comfortable. As with most illnesses, rest and plenty of fluids are recommended.

The best way to expose your child to moist air is to use a cool-mist humidifier or run a hot shower to create a steam-filled bathroom where you can sit with your child for 10 minutes. Breathing in the mist will sometimes stop a child from severe coughing. In the cooler months, taking your child outside for a few minutes to breath in the cool air can ease symptoms. You also can try taking your child for a drive with the car windows slightly lowered.

If you cannot break your child's fast breathing and croupy cough, call your doctor or seek medical attention as soon as possible.

Medical professionals will evaluate your child if the croup appears serious or there is a suspicion of airway blockage. Health care providers often treat croup with steroids (such as Decadron) to decrease airway swelling. For severe cases, a breathing treatment that contains epinephrine (adrenalin) may be given. This reduces swelling in the airway quickly.  In more serious cases oxygen also might be given, and sometimes a child with croup will remain in the hospital overnight for observation.

Frequent hand washing and avoiding contact with people who have respiratory infections are the best ways to prevent spreading the viruses that cause croup.

Terri recently joined the Marshalltown Pediatrics Department. To schedule an appointment, call 641-753-8616.


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