Topic Overview
What is croup?
Croup is a common
respiratory problem in young children. It tends to
occur in the fall and winter. Its main symptom is a harsh, barking cough. Croup
causes swelling and narrowing in the voice box, windpipe, and breathing tubes
that lead to the lungs. This can make it hard for your child to breathe.
An attack of croup can be scary, but it is rarely serious. Children
usually get better in several days with rest and care at home.
What causes croup?
Croup usually occurs a few days
after the start of a cold and is usually caused by the same viruses that cause
the common cold. Croup is contagious. The germs that cause it can be passed
from one person to another through coughing and sneezing and through close
contact. Regular hand-washing and limiting contact with others can help prevent
spreading croup to others.
As children grow older and their lungs
and windpipes mature, they are less likely to get croup. Getting a flu shot
each year may help your child fight off some of the viruses that can lead to
croup.
What are the symptoms?
Symptoms of croup are
caused by narrowed airways. They include a barking cough; a raspy, hoarse
voice; and a harsh, crowing noise when breathing in. The cough is very
distinctive, so you'll know it when you hear it. It is often compared to the
sound of a barking seal. Sometimes children breathe fast and need to sit up to
breathe better.
Symptoms of croup often improve during the day
and get worse at night. Sometimes children have croup attacks that wake them up
in the middle of the night for a couple of nights in a row, but the illness
usually improves gradually in 2 to 5 days.
How is croup diagnosed?
Your doctor will probably
be able to tell whether your child has croup by examining him or her and asking
about symptoms. Sometimes doctors can identify the distinctive barking cough of
croup over the phone.
Because croup can make breathing harder,
your doctor may place a small clip called a
pulse oximeter on your child's finger, toe, or earlobe
to check if enough oxygen is reaching the blood.
How is it treated?
Even though your child's
coughing and troubled breathing can be frightening, home treatment usually
eases the symptoms.
- Try to stay calm during an attack, and soothe your child.
Crying can make the swelling in the windpipe worse and make it even harder to
breathe.
- Breathing in moist air seems to help during a croup attack.
Fill your bathroom with steam from the hot water faucets, and sit in the room
with your child for 10 minutes. Or hold your child directly over a
humidifier, and let the vapor blow directly in his or
her face.
- Breathing cool night air also seems to help sometimes. Dress
your child in warm clothes, and go outside for 10 minutes.
- If symptoms improve with these methods, put your child back in
bed with the humidifier blowing nearby. Do not smoke, especially in the house.
If the symptoms happen during the middle of the night, it is a good idea to
sleep in or near your child's room until morning.
- Be sure to keep your child well hydrated. Offer water,
flavored ice treats (such as Popsicles), or crushed ice drinks several times
each hour.
If your child’s symptoms don't get better after 30
minutes, call or see your doctor. If the attack is in the middle of the night
and you are very worried, consider taking your child to the emergency
room.
If your child has
severe difficulty breathing, call 911 or other emergency services immediately.
If your child has severe
croup or has not responded to home treatment, medicines may be used to decrease
airway swelling. These are usually given in a doctor's office or an emergency
room. In rare cases, a child needs to stay in the hospital for
treatment.
Frequently Asked Questions
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Learning about croup:
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Being diagnosed:
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Getting treatment:
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Symptoms
A child who has
croup may at first seem to have a common
upper respiratory infection (URI), such as a cold. The
first symptoms of URI, such as runny nose and congestion, usually last about 1
or 2 days. Croup symptoms usually follow and last 2 to 5 more days.
Croup symptoms include:
- Normal temperature or a slight fever.
- A loud, barking cough.
- A raspy, hoarse voice.
- Varying degrees of high-pitched crowing sounds when breathing
in.
- Some trouble breathing as a result of swelling in the windpipe.
Unless the illness is severe, a child with croup is usually
alert and active and doesn't appear very sick.
The coughing and
troubled breathing caused by mild to moderate croup may make your child's
condition seem more serious than it really is.
If your child has
severe difficulty breathing, call 911 or other emergency services immediately.
Exams and Tests
A doctor usually diagnoses
croup from a physical exam and a medical
history. During the physical examination, the doctor listens to your child's
chest and back and looks for signs of inflammation or infection in the nose,
ears, mouth, and throat. You will also be asked when your child's symptoms
began, whether they have changed, and whether you have noticed any fever.
Special exams or tests usually are not needed to diagnose croup.
But because the condition may cause difficulty breathing, a
pulse oximeter may be placed on your child's finger,
toe, or earlobe to check the amount of oxygen in the blood. In rare cases, an
X-ray may be needed to look at the throat.
Treatment Overview
Home treatment, such as using a
humidifier, can help treat mild to moderate
croup. Regardless of treatment, symptoms usually
improve gradually within 2 to 5 days.
If your child has severe
croup or has not responded to home treatment, medicines may be used to reduce
airway swelling. These are usually given in a doctor's office or an emergency
room. Medicines usually include:
If your child needs extra oxygen, it is given through a
nasal cannula or delivered through an oxygen mask
placed over the nose and mouth.
If breathing improves after one
or more of these measures, your child will be observed for a short time and
sent home. If symptoms do not improve, your child may need hospitalization and
further testing.
What to Think About
Over-the-counter
cough and cold medicines are not
helpful for treating croup. These medicines may not be safe for young children. Before you give them to a child, check the label. If you do give these medicines to a child, always follow the directions about how much to give based on the child’s age and weight.
Antibiotics
are not effective treatments for croup. These
are only used if a secondary bacterial infection, such as a
middle ear infection, develops.
Home Treatment
Home treatment usually is all that is
needed to treat
croup. You can help prevent major episodes, or
attacks, as well as use techniques to manage attacks if they occur.
Wash your hands often and keep your child away from others to
help prevent spreading croup. Keep your child home from day care or school if
he or she has croup.
Preventing croup attacks
You may be able to
prevent croup attacks of intense troubled breathing and coughing.
If your child has croup:
- Offer plenty of fluids to drink. Always have water available
and try offering other beverages, frozen ice treats (such as Popsicles), or
crushed ice drinks several times each hour.
- Do not smoke, especially in the house.
- Consider using a
humidifier in your child's room. Don't use a hot
vaporizer, and make sure you put only plain water in the humidifier. Although
research has not consistently shown that croup symptoms improve with humidifier
use, using one poses very little risk.1 To prevent
mold growth, be sure to empty, clean, and completely dry out the humidifier
between each use.
Managing attacks of croup
It is important for you
and your child to keep calm during an attack of croup, even though it can be
frightening. If your child is upset, crying, and anxious, the swelling and
narrowing of the airway can become worse. Usually, symptoms sound worse than
they are.
Taking measures to manage an episode of croup, such as
adding moisture to the air and keeping your child calm and comfortable, can
help keep symptoms under control. If coughing and difficulty breathing do not
improve within about 30 minutes despite your efforts, call or see your child's
doctor. Because attacks often occur in the middle of the night, you may need to
visit the emergency room.
Over-the-counter
cough and cold medicines are not
helpful for treating croup. These medicines may not be safe for young children. Before you give them to a child, check the label. If you do give these medicines to a child, always follow the directions about how much to give based on the child’s age and weight.
For more information on
how to deal with croup at home, see:
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Croup: Managing a Croup Attack.
If your child has
severe difficulty breathing, call 911 or other emergency services immediately.
Other Places To Get Help
Organizations
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American Academy of Family
Physicians
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| P.O. Box 11210 |
| Shawnee Mission, KS 66207-1210 |
| Web Address: |
www.familydoctor.org |
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The American Academy of Family Physicians offers information on adult and child health conditions and healthy living. Its Web site has topics on medicines, doctor visits, physical and mental health issues, parenting, and more.
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American Academy of Pediatrics
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| 141 Northwest Point Boulevard |
| Elk Grove Village, IL 60007-1098 |
| Phone: |
(847) 434-4000 |
| Fax: |
(847) 434-8000 |
| Web Address: |
www.aap.org |
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The American Academy of Pediatrics (AAP) offers a
variety of educational materials about parenting,
general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other
organizations are also available.
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KidsHealth for Parents, Children, and
Teens
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| 10140 Centurion Parkway North |
| Jacksonville, FL 32256 |
| Phone: |
(904) 697-4100 |
| Fax: |
(904) 697-4220 |
| Web Address: |
www.kidshealth.org |
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This Web site is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This Web site
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly e-mails about your area of interest.
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References
Citations
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Johnson D (2009). Croup, search date June 2008.
Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Other Works Consulted
- Bjornson CL, et al. (2004). A randomized trial of a
single dose of oral dexamethasone for mild croup. New England Journal of Medicine, 351(13): 1306–1313.
- Cherry JD (2009). Croup (laryngitis, laryngotracheitis, spasmodic croup, laryngotracheobronchitis, bacterial tracheitis, and laryngotracheobronchopneumonitis). In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 1, pp. 254–268. Philadelphia: Saunders Elsevier.
- Hall CB, McBride JT (2010). Acute laryngotracheobronchitis (croup). In GL Mandell et al., eds, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp. 825–829. Philadelphia: Churchill Livingstone Elsevier.
- Kerby GS, et al. (2009). Croup syndrome section of Respiratory tract and mediastinum. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., pp. 478–480. New York: McGraw-Hill.
- Moore M, Little P (2006). Humidified air inhalation
for treating croup. Cochrane Database of Systematic Reviews (3). Oxford: Update Software.
Credits
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By
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Healthwise Staff |
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Primary Medical Reviewer
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John Pope, MD - Pediatrics |
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Specialist Medical Reviewer
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Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics |
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Last Revised
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August 4, 2010 |