The term croup does not refer to a single illness, but rather a group of conditions involving inflammation of the upper airway that leads to a cough that sounds like a bark, particularly when a child is crying.

Causes of Croup

In severe cases of croup, there may also be a bacterial super-infection of the upper airway. This condition is called bacterial tracheitis and requires hospitalization and intravenous antibiotics. If the epiglottis becomes infected, the entire windpipe can swell shut, a potentially fatal condition called epiglottitis.

Other infectious causes of croup include adenovirus, respiratory syncytial virus (RSV), measles, coxsackievirus, rhinovirus, echovirus, reovirus, metapneumovirus, and influenza A and B. Influenza A is associated with severe disease. Influenza A has been implicated in children with severe respiratory compromise.

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.

The classic sign of croup is a loud, harsh, barking cough — which often comes in bursts at night. Your child’s breathing may be labored or noisy. Fever and a hoarse voice are common, too.

The infection starts with a cold, cough, and low-grade temperature. Symptoms gradually develop over 2 days. The typical barking cough is usually present by day 3 and is more likely to be worse at night. The presence of stridor (wheezing on inspiration), hoarseness, difficulty swallowing, and respiratory distress is common but may or may not be severe.

Treatment of Croup

Most children with croup will get better with treatment at home. But if your child’s croup symptoms are severe or don’t seem to be responding to home treatment, call your doctor. He or she may prescribe medication to help reduce the swelling in your child’s airways.

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.

 If your child is distressed, sit them upright on your lap because this helps to keep their airways fully open. It will also provide comfort and reassurance to the child by having you there. This is important because crying and distress can occasionally cause the airways to tighten even more.

On cool nights, exposure to the cool nighttime air may also help symptoms, and this phenomenon is responsible for another characteristic finding of croup, the fact that children often get better on the way to the emergency room.

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