Croup

Croup is a childhood condition that affects the windpipe (trachea), the airways to the lungs (the bronchi) and the voice box (larynx).

It usually affects young children aged between 6 months and 3 years, though a child could be younger or older. Most cases happen in 1 year olds. Croup is more common during the late autumn and early winter months, and it tends to affect more boys than girls. A child can have it more than once.

Croup in adults is rare.

A child with croup has a barking cough that sounds like a seal. When the child breathes in, you may hear a harsh sound called stridor. It's often easiest to notice when the child cries or coughs. The voice may also turn hoarse, and breathing can become difficult because the airway is blocked.

Some children have cold-like symptoms for a few days before the croup starts. The croup symptoms usually last only a few days and are often worse at night. But they can occasionally go on for up to 2 weeks.

Your child:

• has lips or skin that are turning pale, blue or grey (on brown or black skin, this is easier to see on the palms of their hands)
• has severe difficulty breathing, and may make grunting noises or suck their stomach in under their ribcage
• is breathing fast, or stops or pauses
• is pulling in at the throat area (tracheal tug), or their windpipe looks more prominent
• is limp, floppy or not responding like they normally do (they may find it hard to focus on you, or be more difficult to wake up than usual)
• is less than 3 months old, has a temperature of 38°C (101°F) or above, and has not had a vaccination in the past 2 days
• is less than 3 months old, has a temperature of 36°C (97°F) or less, and has not had a vaccination in the past 2 days

With croup, contact your doctor urgently if your child:

• is more short of breath than usual
• has pain when breathing in or coughing
• is feeling confused, dizzy or lightheaded
• feels sick or is being sick, for example if they can't keep food or fluids down
• is coughing up blood (haemoptysis)
• has had a dry nappy for 12 hours or more, or is showing other signs of dehydration
• has a very high or low temperature, for example they feel either hot or cold to touch or are shivering
• has a distinctive barking cough

If your doctor's chamber is closed, phone the 16263 health line.

A doctor can usually diagnose croup. They'll check your child's symptoms, particularly the sound of their cough. If you can, record the noise your child is making on your phone so the doctor can hear it. This can help if your child only coughs at night.

The doctor may also:

• check your child's temperature
• ask whether your child has recently had a cold or viral infection
• do a pulse oximetry test to check your child's oxygen levels (a sensor is clipped onto your child's earlobe or finger, and it does not hurt)
• rule out other conditions with more tests

The doctor will decide whether your child needs to go to hospital or whether the croup is safe to treat at home.

You should not try to check your child's throat yourself. It could trigger a spasm (sudden narrowing) of the airway, and this could make breathing even more difficult.

Most cases of croup are mild, and you can treat them at home.

Sit your child upright and comfort them if they are distressed. This matters because crying may make the symptoms worse. Your child should also drink plenty of fluids so they don't become dehydrated.

Usually, the doctor will prescribe a medicine to help reduce the swelling in your child's throat. It is a single dose of an oral corticosteroid, either dexamethasone or prednisolone. Side effects of these medicines can include restlessness, vomiting, upset stomach and headache.

Steam treatment is not recommended.

If you notice your child's symptoms getting worse, seek urgent medical advice.

If your child has croup, children's paracetamol can ease pain and may help lower their temperature if they have a fever. Children under 16 years of age should not be given aspirin.

If you're unsure what type of pain relief is right for your child, speak to your pharmacist or doctor.

Don't use cough medicines or decongestants. They do not help ease the symptoms of croup. These medicines often make a child drowsy, and that can be dangerous when a child is already having difficulty breathing.

If your child has severe croup, they may need to be treated in hospital. There, they might be given adrenaline or oxygen.

Most of the time, croup is caused by a virus. Several viruses can bring it on, but in most cases the culprit is the parainfluenza virus.

The virus passes from person to person through close contact with someone who is infected, and also through contaminated objects and surfaces. It often spreads when you breathe in droplets from an infected person's cough or sneeze.

Other viruses can also cause croup. These include:

• influenza A and B (flu viruses)
• the measles virus, in children who have not been immunised against measles
• the rhinovirus (common cold virus)
• enteroviruses
• the respiratory syncytial virus (RSV), which can cause severe breathing problems and pneumonia in babies

Croup has some less common causes too:

• breathing in a small object such as a peanut or a pen cap (inhaled foreign body)
• inflammation of the epiglottis (the flap at the base of the tongue that keeps food from going into the windpipe)
• a severe allergic reaction (anaphylaxis), for example to certain foods
• breathing in irritants such as chemicals
• acid leaking back out of the stomach and into the throat (acid reflux)