What is croup?

Croup is an acute viral infection of the upper respiratory tract (a cold) most often heralded by the onset of a “bark-like” cough, fever, and nasal congestion. Croup most often manifests itself during the fall and winter months, although it is not uncommon to have a case in the spring or summer. This viral infection primarily involves younger children (with the peak onset between 6 months and 3 years) because of the small size of their airways.

The onset of croup is often very sudden and most cases will present in the middle of the night. Croup usually starts with fever, nasal congestion, and a “barking” cough (similar to that of a puppy or a seal). This cough is the result of the virus causing swelling of the upper airway around the vocal cords. Other symptoms include hoarseness, sore throat, and difficulty swallowing. Some children may develop increased swelling resulting in a high-pitched sound on inspiration called “stridor” – this symptom is the most bothersome of all.

“What can I expect?”

Croup begins abruptly and is usually worse when lying down at night or for naps. Most often, the symptoms of croup are at their worst over the first 2-3 days. The remainder of the illness is manifested by regular cold symptoms, which eventually resolve in the next few days.

“What can I do at home?”

Some of the most useful home remedies involve helping to alleviate the “bark-like” cough/swelling of the upper airway – a cool mist humidifier, steam/mist or cold air. Steam that has accumulated in a bathroom with a hot shower running or taking your bundled child outside into the cold night air for 10 –15 minutes are the most helpful methods used by parents for their children. Acetaminophen (Tylenol) and Ibuprofen (Motrin, Advil) are useful for fever. Fluids are important for hydration. Cough suppressants may or may not be helpful.

“When should I worry? When should I call?””

Croup involves the infection and swelling of the upper airway, so most of the worrisome symptoms will be related to the respiratory tract—some include rapid breathing or struggling with breathing, stridor or noisy breathing when your child is at rest, uncontrolled drooling, inability to take feeds, listlessness, and irritability. Please call us if any of the above symptoms become apparent! It is not uncommon that stridor worsens when a child is crying or agitated. As with any illness, monitor your child’s fluid intake, output, and activity level.

“What will the physician/nurse practitioner prescribe?”

The large majority of children will require nothing but supportive care and close observation at home. As croup is a viral infection, antibiotics are not helpful and do not change the duration of symptoms. However, on occasion, a brief course of steroids (prednisolone or Decadron) may be necessary to alleviate the upper airway swelling.

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