Croup is a respiratory illness in children that may be caused by multiple viruses including RSV, influenza, adenovirus, rhinovirus, and parainfluenza.  Parainfluenza is the most common cause of croup which is characterized by a barking cough in young children and hoarseness in older kids.  Croup commonly occurs in outbreaks at different times of the year, however parainfluenza is more common in the fall and winter months.  Like other respiratory illnesses, croup is spread by way of respiratory droplets in the air or on contaminated objects such as hands and doorknobs.  There is no specific treatment for the croup (unless it is caused by influenza) although medicines may help lessen the symptoms.  Symptoms usually resolve without treatment within 1 week.

What causes croup?

Multiple viruses including:

• Parainfluenza (the most common cause)
• RSV
• Influenza
• Adenovirus
• Rhinovirus

Inflammation and swelling in the airway (especially below just below the vocal cords) leads to the classic barking cough and hoarseness of croup.

What are the symptoms of croup?

• A barking cough (especially in children between 3 months and 3 years of age)
• Hoarsness (more common in older children)
• Noisy breathing
• Fever (may be mild or absent)
• Malaise (generally feeling sick)
• Runny nose or nasal congestion
• Sore throat

Red Flags (seek medical care immediately)

• Severe or persistent symptoms
• Infants and young children with croup
• Breathing difficulty or rapid breathing
• Inward movement of the chest with breathing (extreme effort required to breath)
• Blue or pale appearance
• Ill-appearing child
• Rash
• Not drinking fluids or not keeping them down
• Decreased urine output
• Excessive sleepiness, confusion or unusual behavior

How is croup diagnosed?

 

The history provided by the patient is usually all that is needed.   Rapid tests for influenza, parainfluenza, RSV and adenovirus can be done.  If a sore throat is a predominant feature then a rapid test for Strep may be necessary.  Blood tests and a chest x-ray can help determine if a serious infection is present, although this is usually not necessary.

 

How is the croup treated?

 

Lots of fluids and rest.  If influenza is diagnosed within 48 hours of the beginning of symptoms, then antiviral medication can be given to shorten the course of the illness. 

 

Other medicines may be used to treat the symptoms:

• Fever & sore throat - ibuprophen and acetaminophen.  These medicines usually make the child feel better and reduce sore throat, making it easier for the child to drink lots of fluids.
• Nasal congestion or runny nose - decongestants (*see note below), saline drops with nasal suctioning in infants, antihistamines (like Benadryl) may help but they are usually avoided due to the sedation side effect
• Cough - cough medicines (*see note below)

*Note - cough and decongestant medicines and typically not recommended for infants and don't work well in children less than 2 years old.

Treatment for severe infection may include:

• Extra oxygen given with a nasal canula (or a breathing machine if necessary)
• Intravenous fluids
• "Breathing treatments" with racemic epinephrine
• Treatment for reactive airway disease or asthma (if present)
• Antibiotics (only if a bacterial infection is suspected)

What are the possible complications of croup?

• Ear infection (otitis media)
• Pneumonia
• Breathing problems

Can croup be prevented?

There is a vaccine available for influenza A.  Antibodies to RSV are given as a shot to premature and other high-risk infants.