Croup is one of the most common viral infections we see in children. It is characterized by swelling and irritation around the vocal cords. This swelling often results in the odd and unique sounds we hear when children with croup cough and breathe. In some cases, especially in younger children, the swelling around the vocal cords can make it difficult to breathe. For most, however, croup is a self-limited viral infection for which we provide “supportive treatment” and “let it runs its course.” Croup can be caused by just about any respiratory virus so we often aren’t able to pinpoint exactly which virus is causing your child to have croup. The one major exception to that is influenza, for which we have a quick and easy test that can be done in the office. Croup is seen year-round but is most common in the colder months of the year (October – March in RVA).
The “croupy cough” has a barking or honking quality, often compared to a barking seal. Not much else causes a barking cough. If your child has a barking cough, he/she likely has croup. The barking cough of croup is notoriously worse at night, and in some cases may only be present at night. The other unique sound we sometimes hear in children with croup is called stridor. Stridor is a gasping, breathing-in sound. It results from the vibration of air through the swollen/narrowed vocal cord area as children take a breath. The other symptoms of croup depend on the virus causing it, but may include any combination of fever, sore throat, runny nose, stuffy nose, headache and sinus pain.
The barking cough (i.e. vocal cord swelling) typically lasts 2-3 days/nights, after which symptoms typically resemble a common cold – wet cough with runny & stuffy nose. These latter symptoms may last for 5-7 days after the barking cough subsides. From a breathing standpoint the first few days of the illness, when the barking cough and/or stridor are present, are typically the most concerning and require the closest monitoring.
If they have a barking cough, they have croup. As stated above, we may not always know which virus is causing croup. If it’s flu season and your child has croup, we may consider testing to see if influenza is the croup-causing virus. Otherwise, management of croup is the same regardless of the virus causing it.
Croup treatment focuses on ensuring the patient can breathe comfortably. Based on your child’s age and the degree of symptoms, your child’s provider may recommend steroids. Steroids are potent anti-inflammatory drugs that shrink the swelling around the vocal cords. They do nothing to treat/kill the virus causing croup, but they do significantly lower the risk of your child having breathing difficulty. At home the best remedies are honey (only for children 12 months and older) & having your child breathe cold air. In colder months, get your child bundled up and stand outside for 5-10 min. As an alternative you can take your child into the kitchen and let them breathe in cold air from the freezer. Breathing cold air works similarly to putting ice on a swollen ankle – the cold shrinks the blood vessels leading to the swollen area, which results in less fluid accumulation/swelling.
Not necessarily. Children 4 years and older with a barking cough typically do not need steroids and can be managed as per the home remedies listed above. Children 0-3 years may benefit from steroids and should be brought in for evaluation. Other reasons for calling us or bringing your child into the office include concerns about: