Croup cough in babies and small children
Croup is the common name for a condition called laryngotracheitis. This is the inflammation and narrowing of the voice box (larynx), the main air tube to the lungs (trachea), and the larger branching air tubes (the bronchi). Croup is usually caused by a viral infection, and can be the result of a number of different viruses.
Croup causes the airways in the lungs to swell, which reduces the flow of air into and out of the lungs. In severe cases, this can make it difficult to breathe.
Croup affects children between the age of 6 months and 6 years. It is most common in children under 3 years old because their airways are narrower and more likely to become blocked when there is an infection.
Croup usually occurs in the winter or early spring, and symptoms are more severe in younger children. Approximately one in ten children are admitted to hospital for a short time until the symptoms ease.
Symptoms of croup cough
Croup is often mild, and children recover quickly. Croup starts like a cold with a stuffy or runny nose and mild fever symptoms. A characteristic ‘barking’ cough usually develops within a day or two, which is caused by inflammation of the vocal chords. The voice may also be hoarse.
Croup causes the trachea to become inflamed and swollen. Thick mucus is also produced on the lining of the trachea (windpipe). The combination of this makes the air passage to the lungs narrower, which means breathing is difficult and painful.
Inhaling is often more difficult than exhaling, and there may be a rasping sound when the child breathes in. This is known as ‘inspiratory stridor’, and may occur when the child is coughing or crying.
Usually it is only seen in severe cases of croup, but it can sometimes happen when the child is sleeping or resting as croup becomes worse.
Croup symptoms often get worse at night, particularly the cough and breathing difficulties. Symptoms are usually most severe during the first three days, and then ease off. A mild cough may last for a further week.
In serious cases of croup, the upper airway may become so swollen that it is very difficult for the child to breathe. You may see the soft tissues of the neck and the area below the ribcage pull inwards during attempts to breathe in.
Breathing is very fast and the child may become agitated.
The child may also appear pale and bluish around the mouth because they are not getting enough oxygen. These symptoms show that the child is very ill and may need hospital treatment.
Causes of croup in infants and elder children
Croup is usually caused by a viral infection. The most common type is the parainfluenza virus, but other viruses such as measles or the influenza virus may also cause it. These types of virus do not always cause the breathing difficulties associated with croup. The symptoms in older children and adults are usually a cough or sore throat.
The viruses are spread through airborne droplets, produced by coughing and sneezing. They can also be passed by touch.
Croup is more common during the winter months and usually occurs in epidemics. Children who are born prematurely or who were born with narrow upper airways are more prone to developing croup.
Rarely, croup is caused by bacteria or an allergic reaction. Now that vaccines are available for diphtheria and Haemophilus influenza type B, the incidence of life-threatening, bacterially mediated croup syndromes is significantly lower than 30 years ago.
Diagnosis and signs of croup
Your GP will diagnose croup on the basis of the symptoms, especially the characteristic cough and appearance of the throat. They will also check the child for fever, cold symptoms, or a recent viral illness.
If the child’s symptoms are severe and do not respond to treatment, an X ray of the neck may be taken to rule out other reasons for the breathing difficulties.
This may be due to a foreign object stuck in the throat, or epiglottis, which is an infection of the flap of skin covering the windpipe. You should not try to examine the child’s throat yourself because you may trigger a spasm of the airways if they have epiglottis.
Treatment for croup cough
In most cases, children with viral croup recover after several days and require no medical treatment. Young children may find croup distressing and is important to try to calm them down and sit them upright to help them to breathe more easily. Make sure that they have plenty of fluids to avoid dehydration. Warm, clear fluids are suitable for older children to help the vocal chords relax.
Warm, moist air can help breathing. Try sitting the child in a steamy bathroom, using a vaporiser or placing a damp towel near a radiator to create moist air.
If the child has fever symptoms, you can give them liquid paracetamol to lower their temperature. However, you should not give cough medicines that cause drowsiness. This will not help a child who may need extra effort to breathe.
Make sure the child avoids smoky environments.
If the child is having difficulty breathing when they are not coughing, and if they are drooling or spitting rather than swallowing their own saliva, it is important to get medical advice straightaway. Medical care should also be sought if the ribs retract when the child breathes in, or if breathing in warm moist does not help to ease symptoms with 20 minutes.
Children with more severe croup may need hospital treatment with humidified oxygen and steroids. Occasionally a tube is put into the trachea through the nose or mouth to help with breathing.
What are the complications?
Very rarely, severe croup may lead to life-threatening airway obstruction. In such cases, hospital treatment is needed to ventilate the child. A tube is passed through the larynx into the trachea to provide oxygen while the child is under sedation for 24-48 hours.
Call your GP straightaway if the child’s condition worsens or any complications develop. Call an ambulance if the child is unable to breathe, if there is blueness around the mouth, or if the skin around the neck or ribcage is drawn in.
Children who are born prematurely or who have a history of lung disease, such as asthma, may develop severe breathing difficulties if they get croup. This sometimes requires treatment in hospital.
Very rarely children show allergic reactions to the croup virus, such as redness, swelling, and respiratory distress. It is very unusual for croup to cause long-term complications.
Rarely, some children develop secondary infections such as an ear infection or pneumonia.
Make sure children wash their hands regularly to avoid spreading germs. Avoiding contact with people with respiratory infections can also reduce the spread of viruses that cause croup.