Croup

What is croup?

Croup is an infection of the larynx (voice box) and trachea (windpipe). These are the upper and lower parts of the breathing tube that connects the mouth to the top of the lungs. The usual cause of croup is a viral infection. Several different viruses can cause croup.

Croup occurs most commonly between the ages of one and three years, but any child under six can develop it. As children become older, their breathing tube becomes firmer and wider. An infection by a similar virus in an older child or adult may cause a cough or sore throat, but is unlikely to cause the breathing symptoms of croup (described below).

Croup often occurs in epidemics in the winter. Boys are more commonly affected than girls. Some children have two or more bouts of croup in their childhood.

• Cough, which is usually harsh and 'barking'. This 'croupy' cough is due to inflammation and swelling of the vocal cords in the larynx.
• Breathing symptoms. The infection causes inflammation and swelling on the inside lining of the breathing tube. There may also be a lot of thick mucus. A combination of these can cause narrowing of the breathing tube. The narrowed tube may cause noisy breathing (stridor). Breathing may become difficult if the narrowing becomes worse.
• Other symptoms include a runny nose, hoarseness, and sore throat. Croup may follow a cold, but can also appear 'out of the blue'. Other cold or 'flu type symptoms may also occur. For example, fever, feeling unwell, being off food, and general aches and pains.

The symptoms are often worse at night. Typically, during the day a child may have a croupy cough with cold symptoms, but not be too unwell. However, at night the cough and breathing symptoms often become worse. Symptoms usually peak after 1-3 days, and then improve. A mild but irritating cough may last a further week or so.

Symptoms are often fairly mild, but sometimes become severe. Croup is common. Many children just get a croupy cough with some cold symptoms. Any breathing difficulty is often mild. Parents can expect to have one or two disturbed nights nursing a coughing child. Most children with croup remain at home and soon recover.

The main concern is if severe narrowing of the breathing tube develops. If this occurs then breathing can become difficult. About 1 in 10 children with croup are admitted to hospital for observation. This is usually if symptoms suggest a narrowing of the breathing tube. Most children admitted to hospital come home within 24 hours as symptoms usually improve quickly. In a small number of cases, a 'ventilator' is needed to help the child to breathe. This is usually just for a short period whilst the infection and inflammation settle down.

What can I do to help a child with croup?

A doctor will normally advise on what to do, or whether hospital admission is needed. The sort of advice your doctor may give is as follows.

• Be calming and reassuring. A small child may become distressed with croup. Crying can make things worse. Sit the child upright on your lap if their breathing is noisy or difficult.
• Lower the fever. If a child has a fever (high temperature) their breathing is often faster, and they appear more ill. To lower a fever:
  • give paracetamol liquid (Calpol, Disprol, etc) or ibuprofen.
  • remove all the child's clothing if the room is not cold.
• Give the child lots of cool drinks.
• Cool air - some people find that it is helpful to have a stroll outdoors, carrying the child upright in the cool fresh air.

Other treatments

• A steroid medicine may be prescribed. Steroid medicines help to reduce inflammation. A single dose often eases symptoms within a few hours. Steroid medicines do not shorten the length of the illness, but they often reduce the severity of breathing symptoms.
• DO NOT give cough medicines which contain ingredients that can make a child drowsy. This will not help a child who may need extra effort to breathe.
• Antibiotics are not usually prescribed as croup is normally caused by a virus. Antibiotics do not kill viruses.

Always consult a doctor if you have any concerns about your child. In particular, see a doctor quickly if:

• The child's breathing becomes rapid.
• The child needs extra effort to breathe, or is struggling to breathe and becomes restless. (Breathing is often noisy with mild croup, but it is difficulty in breathing that is worrying.)
• The child is drooling or unable to swallow.
• A fever persists despite giving paracetamol or ibuprofen and removing the child's clothes.
• The child's colour is pale or going blue. (A normal colour for a child with mild croup is pink or flushed. A change from this to pale or slightly blue is worrying.)

© EMIS and PIP 2006   Updated: February 2006