What is croup?
If young children have a cold and the area around their larynx (voice box) becomes inflamed too, it’s known as croup. The typical symptoms include a barking cough, noisy sounds when breathing in (stridor), and slight breathing difficulties. The symptoms usually go away on their own. If they don’t, or if the breathing difficulties become worse, medication such as steroids can help.
Croup often occurs in the colder months of the year. It is most common in children between the ages of six months and three years: About 3 out of 100 children in this age group have croup per year. Adults only rarely have it.
What are the signs and symptoms of croup?
Children often have a cold with a runny nose and slight fever at first. After a few days, the typical croup symptoms start – in most cases, suddenly at night:
- a “barking” cough
- noisy sounds when breathing in (stridor)
- a hoarse voice
Because the swelling makes the larynx narrower, the children breathe faster and take deeper breaths. Although they usually only have slight difficulties breathing, they often feel scared and cry. This can make the breathing difficulties worse.
Serious breathing difficulties: Call the emergency services
If the child has serious breathing difficulties, call the emergency services (112 in Germany and many other countries, 911 in the U.S.). One typical warning sign is the skin between their ribs being visibly drawn in with each breath. In rare cases the child may turn blue. Or they might be so exhausted that they don’t react to you and are drowsy.
These symptoms could be a sign of a complication such as a narrowed windpipe (trachea). Or they could be caused by a pus-producing inflammation of the epiglottis (a flap in the throat that prevents food and fluids from entering the windpipe and lungs when you swallow).
What can you do yourself?
It’s important that parents stay as calm as possible, be there for their child and comfort them. If the child is scared, the breathing problems may become worse.
Most children only have slight breathing difficulties that go away on their own within two days. Treatment with medication usually isn’t necessary. People are often advised to open the windows: Fresh, cool and moist air are thought to relieve the symptoms. But this hasn’t been proven in scientific studies.
What are the treatment options for croup?
If the symptoms don’t improve or are a real problem for the child, they need to see a doctor. Serious breathing difficulties might have to be treated in a hospital.
The child will usually be given steroids – for instance, in the form of a suppository or tablet, or sometimes as an injection or spray. These medications reduce the inflammation and swelling. A number of studies have shown that they are an effective treatment for croup: After both 6 and 12 hours, children who were given steroid medication were doing better than children who were given a fake medication (placebo). This short-term and sometimes one-time use of steroids hardly caused any side effects. But steroid treatment has one disadvantage: The medication only starts working after a few hours.
If quick help is needed for serious breathing difficulties, an epinephrine (adrenaline) nebulizer is used. This allows the child to inhale the drug as a fine mist. Epinephrine makes the blood vessels in the swollen membranes narrower, which typically reduces the swelling within half an hour. The possible side effects include a racing heart and an increase in blood pressure.
As well as being given medication, children who have serious breathing difficulties are usually given oxygen through an oxygen mask too.
Bjornson C, Russell K, Vandermeer B, Klassen TP, Johnson DW. Nebulized epinephrine for croup in children. Cochrane Database Syst Rev 2013; (10): CD006619.
Johnson DW. Croup. BMJ Clin Evid 2014: pii: 0321.
Lenarz T, Boenninghaus HG. Hals-Nasen-Ohren-Heilkunde. Berlin: Springer; 2012.
Moraa I, Sturman N, McGuire T, van Driel ML. Heliox for croup in children. Cochrane Database Syst Rev 2013; (12): CD006822.
Pschyrembel. Klinisches Wörterbuch. Berlin: De Gruyter; 2017.
Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP. Glucocorticoids for croup. Cochrane Database Syst Rev 2011; (1): CD001955.
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