croup; laryngo-tracheo-bronchitis; stridor; breathing; distress; cough; steroids; adrenalin; smoking; bronchitis; epiglottitis; breath; barking;
Croup is caused usually by a virus infection. A young child (usually under 5 years) becomes mildly unwell with what seems to be a normal 'cold'. The virus infection then causes the lining of the airway (windpipe) in the child's neck to swell, causing the airway to get narrower and making it harder to breathe.
What is croup?
The usual way that croup happens is:
- The child will have been unwell for a couple of days (runny nose, cough, slightly high temperature).
- Then he will wake during the night with a harsh, barking, croupy cough, noisy breathing (stridor) and a hoarse voice.
- This can last a couple of hours, then settle down so he can sleep peacefully. Often it will come back again during the next couple of nights.
- During the day the child is usually well apart from the cold.
- Some older children (aged between 3 and 8 years) may have occasional croup when they don't have a cold. They need to be looked after in the same way.
- Noise when breathing in (called 'inspiratory stridor'), and a 'croupy' (barking) cough.
- Breathing problems. Breathing is hard work, especially breathing in.
- If this difficulty with breathing (respiratory distress) does not settle quickly with comforting and when the child stops crying, this is a sign that the child needs to be seen by a doctor urgently.
If a child is obviously not well and...
- has a high fever,
- has difficulty with breathing,
- makes a noise while breathing (stridor), even when resting
- and/or has difficulty swallowing,
the child should have urgent medical assessment, as this may be epiglottitis.
(See the topic Epiglottitis)
Any child who suddenly starts to cough or have noisy breathing during the daytime, without being unwell, may be choking on something. See a doctor urgently.
Protecting children from croup
- The viruses that cause croup are the same ones that cause the 'common cold'. So it is usually not possible to prevent croup. There is no immunisation against croup (although immunisation against influenza will prevent the few cases of croup that are caused by an influenza virus).
- Most people, including children, who get these viruses will not develop croup - probably only 1 in 10 young children who get the virus infection get croup.
- Keep your home smoke-free.
What parents can do
If a child with croup is very distressed and short of breath, or seems very unwell, the child should be seen by a doctor as soon as possible.
Mild croup is, when a child is calm (stopped crying), she does not have a stridor (noisy breathing) and is not short of breath. Here are some things you could try if the child has a croupy cough but no shortness of breath.
- Having a croupy cough and noisy breathing frightens children, and being scared makes the situation worse. Comforting is very important. Cuddling, sitting the child up (in her parent's arms or on pillows), and giving her something to drink (which helps with the sore throat) can all be important.
- If the child has a fever or sore throat, paracetamol can be used (see the topic 'Using paracetamol or ibuprofen').
- Some people suggest that increased moisture in the air or taking the child outside into cold air may help the child feel better, although these have not been shown to get rid of the problem any more quickly.
- Mild croup generally settles within a couple of hours, and the child goes back to sleep.
If the croup does not settle with comforting, or the child becomes more distressed or unwell, or you are concerned about your child, the child needs to be seen by a doctor.
The topic 'Feeling sick' has suggestions for caring for a sick child.
Treatment of croup by a doctor
- Giving oral steroids (or inhaled steroids if the child cannot use oral steroids) makes the croup last for a shorter time, and fewer children need admission to hospital with this treatment.
- If the child has severe symptoms, nebulised adrenalin (adrenalin is given via a face mask) may also be given in hospital to relieve the spasm and swelling until the steroids work.
- Rarely, children need admission to hospital for intensive care for a day or so.
- Antibiotics do not work because the infection is casued by a virus, and antibiotics do not work against viruses.
Women's and Children's Hospital (South Australia) 'Medical Guideline - Croup'
Fitzgerald DA, Kilham HA, "Croup: assessment and evidence-based management." Medical Journal of Australia vol 179, 6 October 2003, p372-377. http://www.mja.com.au/public/issues/179_07_061003/fit10207_fm.html
Mayo Clinic 'Croup'
Royal Children's Hospital, Victoria 'Croup'
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your child's sex.