Croup

Croup is a disease caused by a virus that leads to swelling in the airways and problems breathing.

• Croup may be accompanied by stridor, a high-pitched sound usually heard when she child breathes in (inspiration).
• Croup is most commonly seen in children 3 months to 5 years old.
• The peak time for croup to occur is 2 years old.
• Boys seem to be more affected by croup than girls.
• Croup is seen more often in the fall and winter.

Keep in mind that each child may experience symptoms differently. As the disease progresses down your child’s respiratory tract, the symptoms can change and may include:

• Runny nose, congestion, and slight cough
• Cough develops into a seal's bark
• Laryngitis
• Fever
• Stridor

Very often, the symptoms are worse at night and may wake your child from sleep. Symptoms also seem to improve in the morning and get worse as the day goes on.

The symptoms of croup may resemble other conditions and medical problems. Always consult your child's physician for a diagnosis.

Croup can be caused by a variety of different viruses. The most common is the parainfluenza virus, but others may include:

• Respiratory syncytial virus (RSV)
• Influenza virus
• Measles
• Adenovirus
• Enteroviruses

Your child may become infected through direct contact with a person, or through the secretions of another person who is infected with the disease. The infection begins in the upper respiratory tract and then slowly spreads down the tract (unlike a cold, which stays in the upper respiratory tract). Swelling affects the area around your child’s larynx (voice box) and into the trachea (windpipe).

Younger children are more affected by croup because their airways are smaller. Therefore, a small amount of swelling can cause a large amount of obstruction in their airways.

In addition to a complete medical history and physical examination, your child’s doctor may also order:

• Neck and chest X-rays: a diagnostic test which uses invisible electromagnetic energy beams to produce images of your child’s internal tissues, bones and organs onto film.
• Blood tests
• Pulse oximetry: an oximeter is a small machine that measures the amount of oxygen in the blood. A small sensor (like a Band-Aid) is taped onto your child’s finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.

Supportive treatments you can do at home that your child's doctor may recommend include:

• Using a cool mist humidifier
• Taking your child outside into cool, dry, night air
• Increasing your child's fluid intake (giving more liquids)
• Treating your child's fever with acetaminophen or ibuprofen, as instructed by your doctor
• Keeping your child as quiet and calm as possible (to help decrease the breathing effort)

Your child's physician may also prescribe the following medications to help alleviate your child's symptoms:

• Breathing treatments (to help open up the airways)
• Injections of medications (to help decrease the swelling in the airways)
• Steroids given by mouth (to also help with the swelling of the airways)

If the croup is severe, or if your child is not breathing well, we may need to hospitalize your child. It can sometimes be hard to tell how severe croup is because the disease fluctuates, and your child may seem better at one moment and then get worse the next.

At Boston Children's Hospital, the Center for Airway Disorders (CAD) provides care and state-of-the-art medical and surgical treatment to children with croup and other complex problems involving the airway, pulmonary and upper digestive tract. The center is staffed by a multidisciplinary team of specialists from various fields who provide comprehensive assessment, treatment and follow-up.