Croup

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Croup is a respiratory illness that affects infants and toddlers, most commonly age 6 months to 3 years. It can also affect older children. It is caused by the parainfluenza virus and has a characteristic barky cough, your child may sound hoarse when talking or crying and if the illness progresses/worsens then you may notice a high-pitched sound like wheezing when they breathe in. The cough can sound a little like a seal barking.  Most cases of croup are mild and can be treated at home.

 Croup can follow a cold so your child may also have a lot of nasal congestion that is not related to the croup. The nasal congestion can worsen the cough due to postnasal drainage. So it is most important to keep your child’s nose clear of mucus as much as is possible. The symptoms of croup are usually worse at night, and your child will awaken with the characteristic barky cough. Croup lasts anywhere from 3 to 7 days but occasionally may last 14 days. 

Another type of croup is called spasmodic croup. This is a type that begins suddenly and can also occur after a mild cold. The cough begins at night and worsens quickly. There is usually no fever. 

Breathing in moist air can help a child with croup feel better and breathe easier. Rest, fluids and a cool mist vaporizer all ease the course of the illness.  If you do not have a vaporizer, you can run a hot shower to create steam in the bathroom, then sit with your child for 15 to 20 minutes. You may need to continue this every couple of hours overnight. Acetaminophen or ibuprofen can also help your child be more comfortable. Remember only children over 6 months of age can have ibuprofen.

Most children with viral croup recover with no complications. But if your child does not seem to be improving over the initial few days you should seek medical help. They may need steroids and a breathing treatment if they are having increasing difficulty breathing. If oxygen levels are low they may require oxygen briefly until they are breathing easier.  The symptoms that would indicate a need to call your pediatrician or go to the ER include difficulty breathing with the skin between the ribs pulling in, a pale or bluish color around the lips, lethargy or seeming exhausted from breathing, signs of dehydration such as dry mucus membranes, no tears, sunken eyes and no urine for several (6-10) hours.