Parents' guide to croup

by Dr Richie Austerberry

Artist: @ellieloomes

It’s that time of the year when croup is most prevalent. Croup is often poorly understood, the early warning signs are easily missed and parent’s can be quite surprised to learn their child has croup. Many parent’s notice the signs “croaky voice”, “sounding wheezy”, “noisy breathing” or “barking cough” which are typically worse at night time, but they may not know these signs suggest croup. We want to help parents learn how to identify croup so they can spot and treat it early and hopefully avoid a trip to the Emergency Department.

What is croup?

Croup is an infection caused by the viruses which cause cold or flu like symptoms. It often starts off with a runny nose, cough and fever but then the child will develop signs of croup as the infection starts to affect the voice box and windpipe. There is no “croup virus”. Croup is simply the set of symptoms that arise from having swelling and inflammation of the voice box or windpipe.

How do I know my child has croup?

Symptoms of croup stem from the way the infection affects the voice box and windpipe. If we understand what these do, then we can learn to recognise the symptoms caused by croup.
 
When we speak our voice box changes its shape to change the volume and pitch of our voice as the air flows over it. In croup, the infection causes your child’s voice box to be inflamed which in turn results in some funny sounds. It may cause them to have a hoarse voice and commonly changes the sound of their cough which is typically harsh and barking in nature (see video).

 

Barking cough in a 6-month old
 
The windpipe is a passageway for air to get to our lungs when we take a breath in. Kids have smaller and floppier windpipes than adults. The virus causes inflammation and swelling and can lead to the windpipe getting narrower. This can make it hard for your child to breath and can cause a harsh high-pitched sound, called stridor (see video) which parents often hear as a wheeze. These symptoms get worse when your child is upset and breathes more deeply, and so calming them can often make the symptoms go away.
 

Notice the high-pitched sound (stridor) when breathing through the narrower windpipe

 

Notice the in-drawing of the chest when the child breaths

 

How bad is my child’s croup?

Most of the time, croup is not serious and your child can be managed at home. However, it is important to be aware that croup can sometimes be severe and your child can deteriorate quickly. To make it easy for you to understand how severe your child’s croup is, it’s easiest to consider it as mild, moderate or severe:

Mild

Your child may have a barking cough and may have noisy breathing (stridor) when they are active or upset. There is no effect on the breathing. When calm, you should notice nothing more than the cough. Croup is often worse at night, so you may find your child has no signs of croup during the daytime.

Moderate

If your child’s croup gets more severe, it will start to affect their breathing. This can cause them to breath quicker, have “in-drawing” of the chest, a “tug” at the neck and flaring of the nostrils (see videos). When moderate, your child will have some noisy breathing present when they are resting.

Severe

When severe, noisy breathing is always present and your child will show marked signs of breathing difficulty.

When should I ask for help?

If you think your child has croup, or you are not sure, you should see your Doctor.
 
If they have mild croup, your child can be given medication and looked after at home. Most children only get mild symptoms and do not need to go to hospital. If they have noisy breathing that is only present when they are active or upset which then disappears when calm, then it is ok to give them medication and observe at home. If you think your child may have mild croup, please seek a review from a doctor as treatment may be recommended.
 
If your child has moderate or severe croup, they should be assessed promptly by the nearest emergency department. The time to go to hospital is if your child gets noisy breathing that doesn’t go away when they are resting.
 
If your child looks very sick, becomes pale and drowsy or their lips are blue in colour you should call an ambulance immediately.

What is the treatment?

Your Doctor may prescribe a steroid liquid for a couple of days to help reduce the swelling and inflammation of the voice box and windpipe. Antibiotics do not help as croup is caused by a virus. The body will fight the virus itself and most kids will recover in 3-4 days.

The best treatment for croup can be settling your child when they are upset as this often makes the noisy breathing go away.

Last time I went to ED my kid's croup was better when I got there. Do I definitely need to go?

The best outcome you can have if you take your child to ED with croup is that they are better by the time you get there. In fact, often this will be the case. The nature of croup is that symptoms can get worse and then better and Doctors understand this. The important thing is to be safe. If your child develops moderate or severe croup, then the safest thing is to be in hospital as a precaution.

My friend says that steam from the shower can help. Is this true?

Some people recommend exposing your child to steam to settle croup symptoms. There is no evidence that shows that this is of benefit. Having said that, there is no evidence that says that it does harm either.
 
We encourage you to do whatever you think it takes to calm your child. This is something you are experts at! We are happy if your child’s noisy breathing is settling when they are calm.  If you find that steam from the shower helps to calm your child and settle their symptoms then go for it!
 
 
This information is general and may not apply to you or another person. If you have any concerns about your health or the health and wellbeing of a child, consult a doctor or other healthcare professional. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.


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