For young kids, colds and coughs are a fairly iconic duo, with the former typically giving way to the latter. But on occasion, a cough that succeeds a virus just doesn’t sound right to parents and caregivers. A likely cause? Croup.
“Croup is a viral attack on the airway below the vocal cords that results in inflammation, and in turn, a gasping-, barking-type of cough,” explains Dr. Kenneth Polin, a pediatrician at Lurie Children’s Primary Care, Town & Country Pediatrics in Skokie, Illinois. “Since children’s airways are smaller, they’re more susceptible to it.”
“Croup is a viral attack on the airway below the vocal cords that results in inflammation, and in turn, a gasping-, barking-type of cough.”
—Dr. Kenneth Polin, pediatrician
While the croup cough sound can be unnerving, it generally isn’t cause for alarm. Here’s what parents and caregivers should know about croup, including how to recognize the signs and how to treat it.
What is croup?
According to Dr. Arethusa Kirk, national senior medical director for UnitedHealthcare, croup is a condition that causes a young child’s voice box and windpipe to swell. “That swelling can make breathing noisy and difficult,” she notes, adding that croup is “most common in children between 3 months and 5 years of age.”
Croup is “most common in children between 3 months and 5 years of age.”
—Dr. Arethusa Kirk, national senior medical director
“After 8 years old, croup is much less common because at this age, children’s airways are bigger and inflammation doesn’t block the airway as much,” Kirk continues, noting that, although croup can occur at any time of the year, it’s most common in the fall and winter months.
What is croup caused by?
Typically, croup is caused by a viral infection, explains Polin, with the culprit most often being one of the following:
- Influenza (flu).
- Parainfluenza.
- Respiratory syncytial virus (RSV).
Kirk notes that croup can also be caused by allergies — referred to as spasmodic croup — but it’s less common. The symptoms of spasmodic croup are similar to croup caused by an infection, but it generally comes on suddenly and isn’t accompanied by a fever. “The cough from viral croup often is associated with a temperature greater than 100.4,” she says.
What does croup sound like?
The croup cough sound is hard to miss. Unlike wet, phlegmy coughs that accompany many colds, croup cough is often characterized as “tight, low and barky — almost like a barking seal,” Kirk says, adding that, in addition to the cough, the child’s voice or cry will be hoarse.
Croup cough is often characterized as “tight, low and barky — almost like a barking seal.”
—Dr. Kenneth Polin, pediatrician
“In more serious cases of croup, children may experience stridor, which is a noisy, harsh, high-pitched breathing sound,” says Kirk. If a child develops stridor as a result of croup (especially if it’s present when the child is resting, as opposed to crying), the American Academy of Pediatrics (AAP) recommends contacting their healthcare provider. In some cases of croup with stridor, the airway can become so swollen that it may be difficult to breathe.
Why is croup worse at night?
Croup usually worsens at night, specifically on the second or third night of the illness, because the body’s natural steroid levels typically decline at night, says Kirk.
“This can lead to increased inflammation, and the voice box swells further,” she explains.
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Does croup go away on its own?
Croup generally goes away on its own without any medical intervention, note Polin and Kirk, with most cases running its course within three to five days.
But even with that being the case, it’s important to try to keep kids as comfortable as possible in the interim, as the Mayo Clinic notes, “crying and distress can worsen airway swelling, making it harder to breathe.”
Natural remedies for croup
Here are a few ways to treat croup at home:
- Humidity. “Wet, steamy air from a humidifier or from the shower — even if the child isn’t taking one — can help alleviate the symptoms of croup,” notes Polin.
- Cold air. “Go outside if the weather is cold,” Polin says. “If we have a patient coming in for croup, we’ll often tell their parent or caregiver to drive with the windows down in the car if it’s safe. Usually, the child is breathing easier by the time they reach us.”
- Keep calm. “Keeping your child calm will reduce further stress and may help your child breathe better when they have croup,” Kirk explains. “Try reading a favorite book or offering a favorite toy, all while remaining calm yourself and offering reassuring words and physical comfort.”
- Consider sleeping in the same room. “When a child has croup, it’s recommended that parents or caregivers sleep in the same room the first few nights to ensure they don’t have trouble breathing,” Kirk says.
- Avoid smoke. “It is very important that children are not exposed to tobacco smoke at any time,” notes Kirk. “But it’s especially crucial when they are ill with a respiratory illness, as smoke can make it significantly worse.”
Parents can also use ibuprofen, Polin says. “Since croup causes inflammation, Motrin often helps,” he notes. “Typically kids will improve about 30 minutes after taking it.”
When should you go to the ER for croup?
If a child is showing signs of compromised breathing, Polin advises calling 911 or taking them to the emergency room, where a steroid may be administered to reduce swelling. That being said, most cases of croup are mild and should improve on their own at home.
“While severe croup cases are rare, ultimately, if you’re concerned or a child’s condition isn’t improving or worsening, contact their medical provider,” Kirk says. “Not only will you get prompt medical advice, you’ll get peace of mind.”
