Croup in Infants and Children: Patient Education

Symptoms tend to be most severe in children under the age of 3.

Croup is a viral infection caused by parainfluenza viruses, adenovirus, respiratory syncytial virus (RSV), or measles virus.

• It is characterized by swelling around the vocal cords. The airway passage swells up causing narrowing of airways.
• The child has a persistent cough that sounds like barks and difficulty in breathing and swallowing. It most commonly occurs in children under the age of 5 years.
• Very rarely croup may be caused by allergies, exposure to inhaled chemicals, and other irritants or bacteria.
• Croup may be dangerous in children and medical advice must be sought in serious cases.
• During the Omicron surge, croup has increasingly been recognized as a manifestation of COVID-19.

Symptoms tend to be most severe in children under the age of 3. This is because children have smaller respiratory systems than adults. Symptoms that are common in most cases of croup include:

• Initial symptoms are similar to that of a common cold like nasal discharge and sneezing
• A recurring, persistent cough that sounds like barking
• Fever
• Difficulty breathing
• Noisy breathing
• Hoarseness of voice
• Difficulty swallowing

Croup can be diagnosed with a complete physical assessment by a physician. An x-ray may be done to rule out other respiratory conditions, foreign bodies, and pneumonia.

Treatment of croup is based on severity. The treatment options include:

For mild cases:

Mild croup can be treated at home, but it is still advised to visit a doctor to confirm the diagnosis. The treatment involves:

• Over-the-counter pain relievers and fever medication can provide symptomatic relief.
• Humidifiers can soothe the cough and throat.
• Do not use an anti-cough medication without consulting with a doctor.

For severe cases:

In severe cases where the child is having difficulty breathing or swallowing, emergency medical attention is required. The treatment may include:

• Steroid medication: This may be injected to widen the airway and reduce swelling. Oral steroids may be prescribed to continue at home.
• A breathing tube may be inserted into the airway for oxygenation.
• Antibiotics may be administered if the cause of croup is suspected to be bacterial and to prevent superadded bacterial infection.
• IV fluids to prevent or treat dehydration.

Croup usually resolves on it its own or with simple home remedies in about a week.

Rarely, croup can worsen, causing life-threatening complications. These include:

• Pulmonary edema (swelling inside the lungs)
• Otitis media (infection of the ear)
• Severe dehydration due to high fever, causing complication
• Pneumothorax (air collection inside the chest cavity)

When to see a doctor:

The following require medical attention:

• Noisy breathing indicates airway obstruction or narrowing of the airway
• Difficulty swallowing
• Bluish-gray discoloration around the nose, mouth, and fingernails, indicating decreased oxygenation
• High-grade fever, over 103.5 degrees
• Symptoms lasting over a week
• Sudden worsening of symptoms

The prevention of croup is similar to most respiratory viruses. This involves maintaining personal hygiene.

•  Frequent handwashing with soap and water for at least 20 seconds at a time.
•  Keeping hands and objects away from the mouth, avoid touching the face.
• Wearing a mask and avoiding direct contact with those with a respiratory infection.
• Avoid close contact with babies when you have a cold.
• Vaccination is available against the measles virus. This virus is one of the causes of croup. It is recommended that parents remain up to date with their child’s vaccinations.