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What to Do for a Child with Croup

This Common Viral Illness can be Frightening for Parents

Oct 4, 2009 Stephen Allen Christensen

The respiratory distress caused by croup can be alarming for both patients and parents; knowing how to respond when croup strikes will help to alleviate those fears.

Croup is a common respiratory infection that causes swelling of the larynx (“voice box”), trachea (windpipe), and bronchi (airways of the lungs). This disease accounts for approximately 15% of childhood respiratory infections seen in doctors’ offices, and up to 5% of children in their second year of life will be seen by a physician for croup. (Malhotra A, Krilov L. Viral croup. Pediatr Rev 2001;22:5-12)

The hallmarks of croup are a hoarse, “seal-like” cough and inspiratory stridor (a whistling noise that is created when a patient inhales through narrowed airways).

Croup can be caused by a variety of infectious organisms, including influenza, adenoviruses, enteroviruses, rhinoviruses, respiratory syncytial virus, measles, and Mycoplasma, but most cases of croup are caused by parainfluenza viruses.

Croup typically occurs during the winter months and mostly affects children from six months to three years of age, but the disease is not unheard of in preadolescent children, teenagers, or even adults. Symptoms of croup in younger children tend to be more pronounced due to their smaller airways.

Signs and Symptoms of Croup

Croup is usually preceded by a few days of cold symptoms (cough, runny nose, fever, etc.).

As swelling of the upper airways ensues, a barking, spasmodic cough develops; stridor is common, and wheezing (a high-pitched, whistling noise heard with exhalation) may be heard.

Symptoms often worsen at night, and a child may awaken with respiratory distress: Rapid, deep breathing, nasal flaring (nostrils spreading apart with inhalation) retractions (visible sinking of the soft tissues at the base of the neck and between and beneath the ribs with each inhalation), and a tendency to sit bolt upright.

Very young children often prefer to be held in an upright position.

Severely affected children may develop cyanosis (bluish lips and fingernail beds), lethargy, and shallow respirations as they weaken.

Croup’s worst symptoms usually last three or four days, although it is not unusual for cold-like symptoms to persist for seven to 10 days.

Home Treatment for Croup

Even though the symptoms of croup can be frightening, most cases are relatively mild and can be treated at home:

Cough medications are usually not helpful, nor are antibiotics, since most cases are caused by viruses.
Maintain adequate rest and hydration. Keeping the child comfortable and quiet is important, as crying or exertion may worsen the condition.
A child can be given acetaminophen (e.g., Tylenol) or ibuprofen (Advil, Pediaprofen, Motrin, etc.) at recommended doses for fever and discomfort.
If stridor develops, it often helps to wrap the child warmly and take him or her outside into cooler air for 10 – 15 minutes.
Humidification of bedroom air with a cold-steam vaporizer or mist-type humidifier helps to moisturize the child’s airways and decrease cough and stridor.
Alternatively, some children with stridor respond to warm, humid air. Running a hot shower in a closed bathroom to generate some mist, and then taking the child into the bathroom for a few minutes may help to relieve stridor.
Occasionally, changing from cooler air to warm, steamy air may be required to “break” the child’s stridor.
Stridor often recurs when the child is returned to bed, so home management may require several trips outside or to the warm bathroom environment. Therefore, it is useful to have more than one responsible person attending to the child so caregivers don’t grow fatigued.
Croup may improve each morning, only to worsen at night for a few days.

If a child exhibits any of the following, he or she should be seen by a doctor:

Drooling
Cyanosis (see above)
Uncontrollable fever (above 102.5ºF in spite of medications)
Confusion, lethargy, or extreme restlessness
Retractions (see above)
Stridor that doesn’t respond to cool air or warm, steamy air

(Adapted from Knutson D, Aring A. Viral croup. Am Fam Phys 2004;69[3]:535-40)

Croup is a common illness that often responds to home treatment. For children who develop severe symptoms, prescription medications and other measures, including hospitalization and respiratory support, are available.

Most cases of croup can be prevented by the same behaviors that prevent other respiratory diseases: Frequent hand washing, coughing or sneezing into sleeves or tissues, prompt disposal or laundering of tissues and handkerchiefs, frequent sanitizing of shared toys and other items, and avoidance of contact with obviously ill individuals.

The copyright of the article What to Do for a Child with Croup in General Medicine is owned by Stephen Allen Christensen. Permission to republish What to Do for a Child with Croup in print or online must be granted by the author in writing.

Humidify Bathroom Air to Treat Croup