Croup refers to an infection of the upper airway, generally in children, which obstructs breathing and causes a characteristic barking cough.
The cough and other symptoms of croup are the result of inflammation around the vocal cords (larynx), windpipe (trachea) and bronchial tubes (bronchi). When a cough forces air through this narrowed passage, the swollen vocal cords produce a noise similar to a seal barking. Likewise, taking a breath often produces a high-pitched whistling sound (stridor).
Croup usually isn't serious and most cases can be treated at home.
Croup often begins as a typical cold. If there is enough inflammation and coughing, a child will develop a loud barking cough. This often is worse at night, and is further aggravated by crying and coughing, as well as anxiety and agitation, setting up a cycle of worsening symptoms. Fever and a hoarse voice are common, too. Your child's breathing may be noisy or labored.
Because children have small airways, they are most susceptible to having more marked symptoms with croup, particularly children younger than three years old.
Nighttime croup symptoms of labored breathing can often lead concerned parents to bring their child to the emergency room.
Symptoms of croup usually last for three to five days.
When to see a doctor
Croup is usually caused by a virus infection, most often a parainfluenza virus.
Your child may contract a virus by breathing infected respiratory droplets coughed or sneezed into the air. Virus particles in these droplets may also survive on toys and other surfaces. If your child touches a contaminated surface and then touches his or her eyes, nose or mouth, an infection may follow.
The infection usually starts in the nasal membranes and then spreads to the vocal cords (larynx) and windpipe (trachea). Only a small percentage of exposed children actually develop croup.
Most at risk of getting croup are children between 6 months and 3 years of age. The peak incidence of the condition is 18 to 24 months of age.
Most cases of croup are mild. In a small percentage of cases, the airway swells enough to interfere with breathing.
Preparing for your appointment
In most cases of croup, your child won't need to see a doctor. However, if your child's symptoms are severe or aren't responding to home treatment, you should make an appointment.
Your child's doctor will likely ask a number of questions to help determine the best course of treatment:
Tests and diagnosis
Croup is typically diagnosed by the doctor observing your child's breathing, listening to your child's chest with a stethoscope and examining your child's throat. Sometimes X-rays or other tests are used to rule out other possible illnesses.
Treatments and drugs
Self-care measures at home are effective for the vast majority of cases of croup. Aggressive treatment is rarely needed.
If your child's symptoms persist beyond three to five days or worsen, your child's doctor may prescribe a type of steroid (glucocorticoid) to reduce inflammation in the airway. Benefits will usually be felt within six hours. Dexamethasone is usually recommended because of its long-lasting effects (up to 72 hours).
Epinephrine is also effective in reducing airway inflammation. It's fast-acting, but its effects wear off quickly.
For severe croup, your child may need to spend time in a hospital. In rare instances, a temporary breathing tube may need to be placed in the child's windpipe.
Croup can be scary — especially if it lands your child in the doctor's office, emergency room or hospital. Comforting your child and keeping him or her calm are important, because crying and agitation worsen airway obstruction. Hold your child, sing lullabies or read quiet stories. Offer a favorite blanket or toy. Speak in a soothing voice.
Lifestyle and home remedies
Croup often runs its course within three to five days. In the meantime, keep your child comfortable with a few simple measures:
Your child's cough may improve during the day, but don't be surprised if it returns at night. You may want to sleep near your child or even in the same room so that you can take quick action if your child's symptoms become severe.
To prevent croup, take the same steps you use to prevent colds and flu. Frequent hand-washing is most important. Also keep your child away from anyone who's sick, and encourage your child to cough or sneeze into his or her elbow.
To stave off more-serious infections, keep your child's vaccinations current. The diphtheria and Haemophilus influenza type b vaccines offer protection from some of the rarest — but most dangerous — forms of upper airway infection.
Last Updated: 2013-01-30
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