Croup in Children

What causes croup?

What causes CroupCroup is caused by an inflammation(swelling) of the upper airway (larynx or voice box and the trachea or windpipe). The inflammation is usually due to a viral infection, and is a common condition in young children. Croup is also known as stridorous laryngitis. Viral croup is more common in children less than 5 years of age and is very rarely seen in adults.

What are the symptoms of croup?

Typically, viral croup begins with a cold, that slowly develops into a characteristic "seal-like" barking cough and a high pitched, raspy noise when breathing in, known as "stridor". The stridor often gets worse with physical activity. Most children with viral croup have a low-grade fever. The potential problems of croup depend on how much the upper airway is blocked by the swelling. The more the airway is blocked, the more the child's breathing is labored and in general, the less active is the child. Additionally, an important sign of difficulty breathing is that the child may stop eating or drinking. Croup typically worsens at night, lasts for 3-4 days and usually subsides on its own. Often the severity of the croup is measured by the "Croup Score" which takes into account a child's breathing rate/pattern and color. The higher the score, the more severe the infection. The croup scores help the medical personnel classify the croup as either mild, moderate or severe.

How is croup treated?

The cough and stridor of croup may be quite scary, but fortunately most cases are mild, and need no other treatment or medical intervention. The type of treatment(if any) depends on the severity of the symptoms.

Mild croup:

The treatment approach is simple: exposure to cold humid air. This is achieved either by opening up a window or taking the child outside. Another way is to let the shower run, preferably with cold water and to let the child sit in the bathroom to breath in the cold humid mist. Usually, children start to breathe more easily within 15 minutes of exposure to cold humid air. During the rest of the croup illness a cold water humidifier or vaporizer in the room during the night is also recommended.

Moderate to severe croup:

In the most serious cases, a child may have so much difficulty breathing that he/she is not getting enough oxygen into the blood. In this situation, the child will need to go to the hospital. Signs that a child with croup needs immediate medical attention include:

  • Stridor that is getting louder with each breath
  • Inability to speak because of lack of breath
  • Labored and or rapid breathing
  • Pale or bluish mouth or fingernails
  • Stridor at rest
  • Drooling
  • Inability to eat or drink enough

At the hospital, the child will be evaluated and given oxygen if necessary.In order to ensure that the child does not become dehydrated, an intravenous may be started. Although there are no specific medications for croup, steroid injections and adrenaline-like inhaled preparations are used to help children with moderate to severe croup. These medications act to decrease the swelling of the upper airway. Some recent studies have suggested that administration of inhaled steroids by mask may also help, but this is still controversial.

Can croup recur?

Yes, some children seem to have repeated episodes of croup called "spasmodic croup". In this case, the child gets a cold, rarely with fever, and then the typical "croup" begins. In some cases spasmodic croup may begin suddenly without any preceding cold symptoms. Unlike viral croup, spasmodic croup usually recurs, can occur in older children and is thought to be related to allergies. Of course in rare cases if a child suffers from repeated episodes of severe croup requiring hospitalization, specific tests are performed by an Ear, Nose and Throat(ENT) doctor to ensure there are no vocal cord or other laryngeal problems/anomalies. Fortunately in the vast majority of children with viral and/or spasmodic croup there is no underlying airway abnormality.