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Croup  

What is croup?

Croup is a common viral infection of the upper airway at the level of the throat, namely the voice box (larynx) and windpipe (trachea). It is a special problem in children, who normally have narrow air passages, and usually occurs from 6 months to 3 years of age but can occur up to 6 years or so. The younger the child, the more susceptible he or she is to croup. It tends to occur in the winter months.

What are the symptoms?

A harsh, 'barking' cough and noisy breathing are the main symptoms. Croup usually begins as a normal cold, then a sore throat, hoarse voice and fever follow. The cough, which is dry, hollow sounding and 'barking', is very characteristic. A stridor (a high-pitched wheezing or grunting noise with breathing) may develop, and this is a serious sign.

Attacks of croup usually occur at night, causing the child to wake up with a fright and a harsh, brassy cough or stridor. The symptoms are worse if the child is upset and may last for 3 or 4 days, but the first 1 or 2 days are the worst.

What is the danger?

Croup is usually a mild infection and settles nicely; however, in younger children it can sometimes cause complete airway obstruction, which is rapidly fatal. These children need to be in hospital to have a tube inserted.

What is the treatment?

Steam in the air

The aim of this treatment is to loosen the thick secretions blocking the airways with humidified steaming air. Take the child to the bathroom and make the air warm and moist by running the hot water taps or a steaming hot shower. The child must never be put under the shower or left alone in the bathroom with the hot taps running. Nursing the child in this atmosphere will settle mild attacks. It is important to keep the child calm.

The air can also be kept moist and warm by simply boiling a kettle. Special nebulisers that produce a fine mist are available for hire from some pharmacists and can be left by the bed as the child sleeps.

Other treatments

• Give the child paracetamol for fever.
• Antibiotics will not help, because croup is caused by a viral infection; however, they are used for any bacterial infection that develops with the croup.
• Stay by the child's bedside until the child settles.
• Have the child propped up in bed or lying on a few pillows for support.

When should you seek immediate medical help?

• Call your doctor or take your child to the hospital urgently if:
• the stridor gets worse and is present when resting or sleeping
• the breathing becomes very difficult
• the child becomes blue and pale
• the breastbone of the chest sucks in on breathing
• the child is floppy and dribbling
• the child becomes very restless or irrational
• the child looks sick and you are most concerned

Key point

• Croup is worse at night.
• Keep the child calm.
• Treat with moist air.
• Croup can be dangerous.
• Get help if you are concerned.

  Copyright 1995: John Murtagh, Professor of General Practice
  Monash University, Melbourne, Australia