What is croup?
We have found that many parents are confused about croup. Croup is a viral illness caused by many of the same viruses that cause the common cold; including parainfluenza viruses, RSV, and adenovirus, among others. Even influenza or “the flu” can cause croup.
The key difference is where the infection centralizes. Rather than the infection causing its most severe symptoms in the nose or lungs, croup is most severe in the airway tissues above the voice box called the larynx. The location of this infection and swelling gives croup its characteristic symptoms.
Many parents will say that their child has a “croupy” cough to mean that the cough is harsh or deep. However, a “croupy” cough is actually quite unique and characteristic due to the laryngeal (above the voice box) swelling. A “croupy” cough is dry and with a characteristic bark-like quality. Many people familiar with the cough describe it as sounding very similar to the bark of a seal.
However, the most concerning symptom is stridor. Stridor is a noisy, high-pitched breathing caused by attempting to breathe past a narrow airway. This can cause increased work of breathing—signaled by breathing fast and/or using chest and neck muscles to breath. Your child frequently will also show the signs of a cold (fever, runny nose, sore throat, etc.) prior to the characteristic cough and possibly stridor.
Aside from the usual supportive care used in common colds (maintaining good hydration, Tylenol or Ibuprofen for pain and/or fever, suctioning the nose, raising the head of their bed, etc.) special efforts are given to try to decrease the swelling in the larynx.
Cool mist and hot steam have both been found to be effective. Humidifiers help rid secretions and can open the airway. You can even take your child outside in the cold air (as infections are most common in the winter) as long as they are dressed warmly. In older children, popsicles and other cold food and drink help decrease swelling.
Children should be seen if you believe you are hearing the characteristic cough. They need to be seen urgently if you believe you are hearing stridor or believe your child is breathing fast or hard. Croup is taken seriously by pediatricians. Due to the location of the infection, if the swelling is severe, the child may not be able to breath past it at all. Concern for dehydration is another reason to have your child seen.