• Amelia Colley, M.D., FAAP
  • Philip Dawson, M.D., FAAP
  • Scott Iwashyna, M.D., FAAP

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Croup

Croup is a co‚Äčmmon illness in young children. It can be scary for parents as well as children.

What is Croup?

Croup is a condition that causes a swelling of the voice box (larynx) and windpipe (trachea). The swelling causes the airway below the vocal cords to become narrow and makes breathing noisy and difficult. It is most commonly caused by an infection. 

Children are most likely to get croup between 3 months and 5 years of age. As they get older, it is not as common because the windpipe is larger and swelling is less likely to get in the way of breathing. Croup can occur at any time of the year, but it is more common in the fall and winter months. 

Types of Croup
Viral Croup

This is the most common type of croup. It is caused by a viral infection of the voice box and windpipe. It often starts out just like a cold, but then it slowly turns into a barky cough. Your child's voice will become hoarse and her breathing will get noisier. She may make a coarse musical sound each time she breathes in, called stridor. Most children with viral croup have a low fever, but some have temperatures up to 104°F (40°C). 

Spasmodic Croup

This type of croup is thought to be caused by an allergy or by reflux from the stomach. It can be scary because it comes on suddenly, often in the middle of the night. Your child may go to bed well and wake up in a few hours, gasping for breath. She will be hoarse and have stridor when she breathes in. She may also have a barky cough. Most children with spasmodic croup do not have a fever. This type of croup can recur. It is similar to asthma and often responds to allergy or reflux medicines. 

Croup with Stridor

Stridor is common with mild croup, especially when a child is crying or active. But if a child has stridor while resting, it can be a sign of more severe croup. As your child's effort to breathe increases, she may stop eating and drinking. She also may become too tired to cough, and you may hear the stridor more with each breath. 
The danger of croup with stridor is that sometimes the airway may swell so much that your child may barely be able to breathe. In the most severe cases, your child will not be getting enough oxygen into her blood. If this happens, she needs to go to the hospital. Luckily, these most severe cases of croup do not occur very often. 

Home Treatment for Croup

If your child wakes up in the middle of the night with croup, try to keep him calm. Keeping him calm may help him breathe better.

Ways to comfort your child may include:

Giving your child a hug or a back rub
Singing a favorite bedtime song
Offering reassuring words such as, "Mommy's here, you will be OK"
Offering a favorite toy

If your child has a fever (a temperature of 100.4°F [38°C] or higher):

Treat it with acetaminophen or ibuprofen (for children older than 6 months), as needed. Make sure he is drinking fluids to avoid dehydration. 

In the past, parents may have been advised to try steam treatment in the bathroom. Though some parents may find that this helps improve breathing, there are no studies to prove that inhaling steam in a bathroom is effective. There are also no studies to prove that breathing in moist, cool night airs helps improve breathing.  

When to Call the Doctor

If you are concerned that your child's croup is not improving, contact your child's doctor, local emergency department, or emergency medical services (911) even if it is the middle of the night. Consider calling if your child: 

Makes a whistling sound that gets louder with each breath
Cannot speak or make verbal sounds for lack of breath
Seems to be struggling to catch her breath
Has bluish lips or fingernails
Has stridor when resting
Drools or has extreme difficulty swallowing saliva

Treating Croup with Medicine

If your child has viral croup, your child's doctor or the emergency department doctor may give your child a breathing treatment with epinephrine (adrenaline) to decrease the swelling. After epinephrine is given, your child should be observed for 3 to 4 hours to confirm that croup symptoms do not return. 

A steroid medicine may also be prescribed 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. Steroids may decrease the intensity of symptoms, the need for other medications, and time spent in the hospital and emergency department. 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 they are almost always caused by a virus or by allergy or reflux. Cough syrups are not useful and may do harm.