Croup
What is Croup?
Croup is an inflammation of the voice
box (larynx) and windpipe (trachea). When a child
has croup, the airway just below the vocal cords becomes
swollen and narrow. This makes breathing noisy and
difficult.
Some children get croup often, such as whenever they
have a respiratory illness. Children are most likely
to get croup between 6 months and 3 years of age.
After age 3, it is not as common because the windpipe
is larger, so swelling is less likely to get in the
way of breathing. Croup can occur at any time of the
year, but it is more common between October and March.
There are two different types of croup:
• Spasmodic croup is usually
caused by a mild upper respiratory infection or allergy.
It is often frightening because it comes on suddenly
in the middle of the night. Your child may go to bed
with a mild cold and wake up in a few hours, gasping
for breath. He will also be hoarse and have a cough
that sounds like a seal barking. Most children with
spasmodic croup do not have a fever. This type of
croup can reoccur.
• Viral croup results from
a viral infection in the voice box and windpipe. This
kind of croup often starts with a cold that slowly
develops into a barking cough. As your child's airway
swells and she secretes more fluid, it becomes harder
for her to breathe. Her breathing will also get noisier,
and it may make a coarse musical sound each time she
breathes in. This condition is called stridor. Most
children with viral croup have a low fever, but some
have temperatures up to 104°F.
As your child's effort to breathe increases,
he may stop eating and drinking. He also may become
too tired to cough, although you will hear the stridor
more with each breath. The danger with croup accompanied
by stridor is that the airway will keep swelling.
If this happens, it may reach a point where your child
cannot breathe at all.
Stridor is common with mild croup, especially when
a child is crying or moving actively. But if a child
has stridor while resting, it can be a sign of severe
croup.
Treating Croup
If your child wakes up in the middle
of the night with croup, take her into the bathroom.
Close the door and turn the shower on the hottest
setting to let the bathroom steam up. Sit in the steamy
bathroom with your child. Within 15 to 20 minutes,
the warm, moist air should help her breathing. (She
will still have the barking cough, though.)
For the rest of that night and 2 to
3 nights after, try to use a cold-water vaporizer
or humidifier in your child's room. Sometimes another
attack of croup will occur the same night or the next.
If it does, repeat the steam treatment in the bathroom.
Steam almost always works. If it does not, take your
child outdoors for a few minutes. Inhaling moist,
cool night air may loosen up the air passages so that
he can breathe more freely. If that does not help,
consult your pediatrician about other options. If
your child's breathing becomes a serious struggle,
call for emergency medical services. (In most areas,
dial 911.)
Never try to open your child's airway
with your finger. Breathing is being blocked by swollen
tissue out of your reach, so you cannot clear it away.
Besides, putting your finger in your child's throat
will only upset her. This can make her breathing even
more difficult. For the same reasons, do not force
your child to throw up. If she does happen to vomit,
hold her head down and then quickly sit her back up
once she is finished.
Your pediatrician will ask if your child's
breathing is better after the steam treatment. If
it is not, your pediatrician may prescribe a steroid
medication to reduce swelling in the throat or shorten
the illness. Although it has not been firmly proven
that this works, treatment with a steroid for 5 days
or less should do no harm.
Antibiotics, which treat bacteria, are
not helpful for croup because the problem is almost
always caused by a virus or allergy. Cough syrups
are of little use too, because they do not affect
the larynx or trachea, where the infection is located.
These also may get in the way of your child coughing
up the mucus from the infection.
If you suspect your child has croup,
call your pediatrician—even if it is the middle
of the night. Also, listen closely to your child's
breathing. Call for emergency medical services immediately
if he:
• makes a whistling sound that
gets louder with each breath
• cannot speak for lack of breath
• seems to be struggling to get a breath
• seems very pale or has a bluish mouth or
fingernails
• has stridor when resting
• drools or has extreme difficulty swallowing
saliva
In the most serious cases, your child
will not be getting enough oxygen into her blood.
If this happens, she may need to go into the hospital.
There she may be put in a plastic tent, called a croup
tent, to receive oxygen. She may also be fed through
a vein and take medication by inhaling it. Sometimes
a tube is inserted through the nose or mouth into
the windpipe to bypass the swelling in the larynx
and trachea. Your child may be hoarse for a while
after the tube is removed, but this usually does not
last. Luckily, these severe cases of croup do not
occur very often.
© Copyright 2000 American Academy
of Pediatrics
