What Is Croup?

By amara
Reviewed: Dr. Gromatzky
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Most people have heard of the common cold, but unless you have children, you may not have heard of croup. Croup typically only affects children and usually gets better on its own without medical treatment. Typically, croup develops after a common cold or other types of common viruses.

Although some of the symptoms of croup can be the same as other conditions, croup has some distinct symptoms that are easy to identify. Learning more about the signs of croup can help parents learn to distinguish between this issue and other potential problems. This will allow parents to prepare for proper treatment.


1. What Is Croup?

Croup is a condition that develops when the areas around the larynx and trachea become inflamed due to a cold or another virus. The air pathway between the bronchial tubes and the larynx becomes swollen and narrowed, so when the child coughs, the air must be pushed through a smaller passageway than usual.

Not all viruses lead to croup in children. Inflammation that does not specifically affect the voice box or inflame the trachea and bronchial tubes does not lead to croup symptoms, even with infection or irritation of the upper or lower respiratory tract. Croup develops with a specific set of symptoms.


2. What Are the Symptoms of Croup?

Croup has a very distinctive set of symptoms that sets it apart from other conditions. First, the sound of a croupy cough is very noticeable. Since the larynx is inflamed, a croupy cough does not sound like a typical cough. Instead, it is described as a barking cough, similar to the sound of a seal barking. This barking cough is due to the swelling of the vocal cords and can be alarming the first time a parent encounters it. Children with croup sometimes run a fever, although the fever is typically not a high grade.

Another typical symptom of croup is a whistling sound when the child inhales a breath. The whistle is high pitched and can worry parents that the child is having difficulty breathing, even though this is not typically the case. The swollen vocal cords are the whistling culprit, although there is plenty of room for air to pass through. High-pitched whistling during an inhaled breath is referred to as stridor. Some children have labored breathing or breathing that becomes noisy. The persistent cough can also cause hoarseness in the voice.


3. How Is Croup Different from a Cold?

Many parents assume that a cough that is persistent or loud is a sign of croup, but this is not the case. Most instances of the common cold in children do not lead to croupy conditions. Upper respiratory illnesses with symptoms such as a runny nose, sneeze or postnasal drip are signs of a common cold but do not always lead to a case of croup.

Deteriorating lower respiratory conditions also do not necessarily lead to croup. A child can have a cough, bronchitis or even pneumonia, but unless the vocal cords and trachea are inflamed and there is a distinct barking cough, no croup is present. The difference between a common cold and croup is that a cold can lead to the development of croup, but croup cannot develop in the absence of a virus or infection.


4. How Is Croup Diagnosed?

In many cases, a child who is exhibiting symptoms of croup but is recovering comfortably at home does not need to receive a formal diagnosis at a doctor’s office or any kind of advanced treatment. The distinctive barking cough makes it easy to determine if a child has developed the condition, and parents can proceed with at-home treatment accordingly.

For those who visit the doctor for a diagnosis, the physician listens to the child’s lungs and chest with a stethoscope and make a note of any concerns. The physician will also take time to observe the child’s breathing sounds and patterns and listen to the cough. In some cases, X-rays or other tests may be completed to confirm the diagnosis or rule out other potential causes for the symptoms.


5. How Long Does Croup Last?

Uncomplicated cases of croup typically resolve in less time than the virus that causes the symptoms. During the day, symptoms are usually milder and can seem to be resolving. At night, symptoms tend to worsen, but since this is a typical pattern of symptom fluctuation, it does not mean the condition is worsening.

When a child cries or gets upset, the symptoms can also seem to worsen, but this does not mean the condition is getting worse. Although the cold may last for a week or more, croup is usually shorter-term and will resolve within three to five days. Some cases do get worse with time, so the child should be evaluated by the doctor if symptoms are worsening or have lasted longer than five days.


6. Who Is at Risk for Croup?

Children are most at risk for croup, particularly those who are between six months and three years of age. It is believed that the airways are already narrow in younger children, so any type of inflammation is likely to cause enough tightness in the vocal cords to cause symptoms of croup.

Since croup is caused by having the common cold, children are more likely to develop the condition simply because they are more likely to catch a cold. Children touch things and put their hands in their mouths more frequently than adults and have not yet built up a strong immune system the way adult patients have.


7. How Is Croup Treated?

Many cases of croup can be treated at home and need no more treatment than the cold or virus that caused it. Since crying or being upset can make a croupy cough worsen, using various methods to keep the child comfortable and relaxed can reduce symptoms. Liquids and rest can go a long way toward recovery. Moist air can also be comforting if the child feels like the airway is tight. Steam from a shower can help moisten the airways. If the air outside is cold, it can help to ride in a vehicle with the windows down and allow the child to breathe in the cold air. In general, cough medicines will not improve the symptoms of this condition.

In some cases, croup develops symptoms that are more concerning, and a visit to the doctor is needed. Doctors examine the patient to determine if the course of treatment should include prescription medication or, in the worst cases, hospitalization. Medicine to treat croup focuses on reducing inflammation to allow the airway to open up. Some steroids that are approved for use in children can be effective quickly and bring relief for a long time. Another option is epinephrine, which is typically used in conjunction with a nebulizer while under the watch and care of a physician.


8. Is Croup Dangerous?

Although most cases of croup resolve on their own within a few days, there are some cases that require a visit to a physician or a hospital. For the majority of children, croup does not end up being dangerous. If the condition has lasted longer than five days and has started to worsen instead of improving, it is time to call the doctor to see if more intervention is needed.

Other indicators that a visit to the doctor is needed are when symptoms become concerning, severe or unmanageable at home. Noises that are high pitched when breathing in and out, especially if the child is not upset or crying, can be an indicator that the airway is more restricted. A fast respiratory rate, difficulty breathing or skin that has taken on a bluish or grayish tint mean that emergency care is needed.


9. How Can Croup Be Prevented?

Prevention of croup involves the same preventive measures as avoiding viruses such as the cold and flu. Since croup is caused by inflammation that is a reaction to a virus, the only way to prevent croup is to prevent viral infection.

Some of the best ways to prevent viruses are frequent hand washing, avoiding spending time with people who are sick and staying up to date with vaccinations so that airways remain healthy from other types of upper respiratory conditions.


10. How Should a Child Be Comforted During Croup?

Since agitation, crying and being upset can exacerbate croup symptoms, it is helpful for parents to keep their children relaxed and calm while the condition progresses. This can be difficult since coughing and tightness in the airways can be upsetting. Breastfeeding mothers can comfort a child through feeding, while other methods of comfort include rocking, singing and holding the child upright to encourage healthy breathing.

Croup is a common childhood illness caused by a virus and is usually self-limiting without any treatment. Keeping the child comfortable while the condition progresses and bringing the child in to be evaluated by a doctor if the condition seems to worsen are the best methods of treatment for croup. Luckily, most cases resolve within a few days with little to no treatment and no lasting effects.


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