Croup

Published by Bupa's Health Information Team, April 2010.

This factsheet is for parents of children who have croup, or people who would like information about it.

Croup is the common name for laryngotracheitis. This is when the voice box (larynx), trachea (windpipe) and airways from the lungs (bronchi) become infected. It's a common condition and rarely has serious consequences.

Croup mainly affects children under the age of six. Often no treatment is needed, but sometimes medicines will be prescribed.

About croup

Croup is an infection of the upper parts of the respiratory (breathing) system, and is characterised by a barking cough. It makes the airways inflamed and swollen and causes thick mucus to be produced, making it difficult for air to move into and out of the lungs.

About three in every 100 children will get croup each year. It mainly affects children between the ages of a few months and six years old, but children are most likely to get it if they are under three. This is because at this age, children's windpipes and airways are smaller and so they are more likely to become narrower if they are infected. For this reason, the symptoms are usually more severe in younger children.

Children may get croup more than once. It occurs more often during the autumn and spring in the UK.

Symptoms of croup

The most obvious symptom of croup is a barking cough, which may start suddenly during the night. The cough has been compared to the noise made by a seal. Your child may have a runny nose, cough, sore throat and mild fever (38-39°C) for a few days before the cough starts.

Other symptoms of croup include:

• noisy breathing - a rasping sound when breathing in (stridor) or wheezing when breathing out
• hoarse throat
• problems with breathing
• the chest moving up and down more than normal during breathing
• a high fever (40°C or more)

You may find that your child's symptoms are worse at night. Symptoms usually last between three and seven days, though your child may be ill for up to two weeks.

These symptoms may be caused by problems other than croup. You should visit your GP for advice.

Complications of croup

Croup doesn't usually last for longer than a few days. However, occasionally children who have severe croup can develop an ear infection or pneumonia (inflammation of the lungs).

If the infection is severe, the airways can become so narrow that your child can't breathe. If this happens, your child will need to go to hospital for treatment. About one in 20 children with croup need to go to hospital (see hospital treatment).

It's important that you contact your GP immediately if your child's condition gets worse. You should call an ambulance for emergency help if your child has a rapid heart beat, can't breathe, seems unusually sleepy, has blueness around the mouth or if the skin around his or her neck or ribcage is drawn in.

Causes of croup

A virus called parainfluenza causes croup in three-quarters of children who get croup. Other viruses, including the respiratory syncytial virus and the measles virus, can cause croup. Occasionally it may be caused by bacteria.

Diagnosis of croup

Your GP will ask about your child's symptoms and examine him or her. Your GP may also ask about your child's medical history. Usually this will be enough to diagnose croup.

Stridor and other breathing problems may also be caused if something is lodged in the throat or by infections other than croup. If your GP isn't sure what is causing the symptoms, he or she may refer your child to a ENT (ear, nose and throat) surgeon.

Treatment of croup

Most children who develop croup will get better within a couple of days and won't need to have any medical treatment. In some children, the infection may last up to a week.

Self-help

It's important to make sure that your child drinks plenty of fluids so that he or she doesn't get dehydrated. Your child's symptoms will probably be better if he or she stays as upright as possible.

Steam inhalation has been used for many years to treat croup, but there is no scientific evidence to show that it actually works. However, if your child only has mild croup, you may find that it's helpful in making him or her more comfortable.

You can create a steamy atmosphere by running the hot taps in your bathroom and closing the door to keep the steam inside. It's very important that you keep your child away from the hot water and take care not to scald him or her. You can also buy air humidifiers.

Medicines

Your GP may prescribe a type of medicine called a corticosteroid. Your child is likely to receive one dose, taken by mouth, of a medicine called dexamethasone or prednisolone. This medicine is very effective at relieving the symptoms of croup, and your child probably won't need any further medical treatment.

Cough medicines and decongestants don't help and you should not give these to your child.

Hospital treatment

If your child has more severe croup he or she will need to go to hospital. There, doctors can help your child get more oxygen by using "blow-by" oxygen, where a hose of oxygen is held near the nose and mouth.

Your child may need another kind of steroid medicine called budesonide, which has to be inhaled as a gas through a mask with a nebuliser. Some young children find this upsetting.

If this does not help, your child may also be given an inhalation of adrenaline with a nebuliser. This is a hormone (chemical produced by your body) that can be made artificially. It causes the airways to widen and the effect lasts for about two to three hours.

If the medicines don't help, your child may need to have a tube put into the windpipe to breathe. This happens in fewer than two in 100 children who go to hospital with croup.

Prevention of croup

Croup is spread by droplets in the air which are released when someone with the infection coughs or sneezes. The disease can also be passed on by touching a surface that has been contaminated. You can reduce the risk of croup by making sure your child washes his or her hands regularly.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.