Croup

Croup is a common respiratory infection that affects the upper airway, leading to a narrowing that makes breathing difficult. This condition often results in a distinctive barking cough, which can be alarming for both children and their parents.

What Causes Croup?

Croup is typically caused by a viral infection, most commonly the parainfluenza virus. The infection leads to swelling and irritation around the voice box (larynx), windpipe (trachea), and bronchial tubes (bronchi). As the child coughs, air is forced through this narrowed passageway, causing the swollen vocal cords to produce a noise similar to a seal barking. Additionally, breathing in may produce a high-pitched whistling sound known as stridor.

Symptoms of Croup

Croup often begins with symptoms resembling those of an ordinary cold. However, as the condition progresses, the following symptoms may develop:

• Loud, Barking Cough: This characteristic cough worsens with crying, coughing, anxiety, and distress, creating a cycle of worsening symptoms.
• Fever: A mild to moderate fever is common.
• Hoarse Voice: Swelling around the vocal cords causes a hoarse voice.
• Noisy or Labored Breathing: Stridor and difficulty breathing can occur, especially at night.

Symptoms of croup usually peak at night and can last for 3 to 5 days.

When to See a Doctor

While most cases of croup can be managed at home, it's important to contact a healthcare provider if:

• Symptoms are severe or worsening.
• Symptoms last longer than 3 to 5 days.
• Symptoms do not respond to home treatment.

Seek immediate medical attention if your child:

• Makes high-pitched breathing sounds when inhaling and exhaling.
• Produces high-pitched breathing sounds when not crying or upset.
• Begins drooling or has difficulty swallowing.
• Appears anxious, restless, or unusually tired.
• Breathes at a faster rate than usual.
• Struggles to breathe or shows signs of respiratory distress.
• Develops a blue or gray tint around the nose, mouth, or fingernails.

Risk Factors

Children between 6 months and 3 years old are at the highest risk for croup due to their smaller airways. Croup is less common in children over 6 years old.

Complications

Most cases of croup are mild, but in a small number of children, the swelling can cause significant breathing problems. Rarely, a secondary bacterial infection of the windpipe can occur, necessitating emergency medical care. Hospitalization is required for only a small percentage of children seen in the emergency room for croup.

Prevention

Preventing croup involves the same measures used to prevent colds and flu:

• Frequent Hand-Washing: Wash hands with soap and water for at least 20 seconds.
• Avoid Contact with Sick Individuals: Keep your child away from anyone who is ill.
• Encourage Proper Coughing and Sneezing Etiquette: Teach your child to cough or sneeze into their elbow.
• Clean Frequently Touched Surfaces: Regularly disinfect toys and surfaces.
• Vaccinations: Keep your child's vaccinations up to date, including the diphtheria and Haemophilus influenzae type b (Hib) vaccines, which protect against some serious upper airway infections. Note that there is currently no vaccine for parainfluenza viruses.

By understanding the causes, symptoms, and preventive measures, parents can better manage croup and seek appropriate medical care when necessary.

Sources

• Mayo Clinic. (2022). Croup.
• WebMD. (2022). Croup in Children.
• American Academy of Pediatrics. (2022). Croup.