Croup is a common
respiratory problem in young children. It tends to
occur in the fall and winter. Its main symptom is a harsh, barking cough. Croup
causes swelling and narrowing in the voice box, windpipe, and breathing tubes
that lead to the lungs. This can make it hard for your child to breathe.
An attack of croup can be scary, but it is rarely serious. Children
usually get better in several days with rest and care at home.
What causes croup?
Croup usually occurs a few days
after the start of a cold and is usually caused by the same viruses that cause
the common cold. Croup is contagious. The germs that cause it can be passed
from one person to another through coughing and sneezing and through close
contact. Regular hand-washing and limiting contact with others can help prevent
the spread of croup.
As children grow older and their lungs
and windpipes mature, they are less likely to get croup. Getting a flu vaccine
each year may help your child fight off some of the viruses that can lead to
What are the symptoms?
Symptoms of croup are
caused by narrowed airways. They may include:
A barking cough. The cough is often compared to the
sound of a barking seal. You'll know it when you hear it.
A raspy, hoarse
A harsh, crowing noise when breathing in. Sometimes children breathe fast and need to sit up to
Symptoms of croup often improve during the day
and get worse at night. Sometimes children have croup attacks that wake them up
in the middle of the night for a couple of nights in a row. Unless the illness is severe, a child with croup is usually alert and active. The child's temperature is usually normal or only slightly higher than normal.
The illness usually improves in 2 to 5 days.
How is croup diagnosed?
Your doctor will probably
be able to tell whether your child has croup based on your child's symptoms and a physical exam. The doctor may be able to identify the barking cough of
croup over the phone.
The doctor may place a small clip called a
pulse oximeter on your child's finger, toe, or earlobe
to make sure that enough oxygen is reaching the blood.
How is it treated?
Even though your child's
coughing and troubled breathing can be frightening, home treatment usually
eases the symptoms.
Try to stay calm during an attack, and soothe your child.
Your child's crying can make the swelling in the windpipe worse and make it even harder to
Breathing in moist air seems to help.
Fill your bathroom with steam from the hot water faucets, and sit in the room
with your child for 10 minutes. Or hold your child directly over a
humidifier, and let the vapor blow directly in his or
Breathing cool night air also seems to help sometimes. Dress
your child in warm clothes, and go outside for 10 minutes.
If symptoms improve with these methods, put your child back in
bed with the humidifier blowing nearby. If the symptoms happen during the middle of the night, it is a good idea to
sleep in or near your child's room until morning.
Be sure to keep your child well hydrated. Offer water,
flavored ice pops (such as Popsicles), or crushed-ice drinks several times
Do not let anyone smoke around your child or in the house.
Do not give your child over-the-counter cough or cold medicines. They don't help with croup, and they may not be safe for young children.
If your child's symptoms don't get better after 30
minutes, call your child's doctor. Because attacks often occur in the middle of the night
when your doctor is probably not available, you may have to go to the emergency
When home treatment isn't enough, medicines such as glucocorticoids or epinephrine may be used to decrease
airway swelling. These are usually given in a doctor's office or an emergency
room. In rare cases, your child may need to stay in the hospital to get extra oxygen or other treatment.
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Cherry JD (2009). Croup (laryngitis, laryngotracheitis, spasmodic croup, laryngotracheobronchitis, bacterial tracheitis, and laryngotracheobronchopneumonitis). In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 1, pp. 254–268. Philadelphia: Saunders Elsevier.
Federico MJ, et al. (2011). Respiratory tract and mediastinum. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 487–535. New York: McGraw-Hill.
Hall CB, McBride JT (2010). Acute laryngotracheobronchitis (croup). In GL Mandell et al., eds, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp. 825–829. Philadelphia: Churchill Livingstone Elsevier.
Johnson D (2009). Croup, search date June 2008.
Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
John Pope, MD - Pediatrics
Thomas Emmett Francoeur, MD, MDCM, CSPQ, FRCPC - Pediatrics
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