Croup

Croup is caused by the same viruses that cause a common cold. The most common virus that causes croup is called parainfluenza virus. It is spread by sneezing, coughing and close personal contact.

The virus may also survive on toys and other surfaces. If your child touches a contaminated surface and then touches his or her eyes, nose or mouth, this may cause the infection.

Children with croup will usually have an illness like a cold first, with a runny nose, cough and may have a slight temperature. As children are small, their airways are already narrow. When the cold virus causes swelling of the wind pipe and voice box, this can result in noisy breathing and a harsh, barking cough. This can happen particularly when the air is cold.

The noisy breathing and barking cough often occurs at night time, and can last a couple of hours and reappear for the next couple of nights.

Symptoms of croup include:

• noisy breathing (also called stridor)
• harsh, barking cough
• hoarse voice
• difficulty breathing – depending on how severe the illness is.

Most children with croup do not need treatment and can be managed at home, however in a few children, the croup is more severe and causes trouble breathing.

If your child’s symptoms don’t settle quickly with comforting and once they stop crying, your child needs to be seen by a doctor urgently, and may need treatment or observation in a hospital.

The symptoms of croup are similar to those caused by other, much more serious conditions, and so it is important that a doctor checks your child.

At home

You can treat your child at home if she or he has no breathing problems or noisy breathing when they are not crying. Most children with croup will only need treatments like you would give for a cold. Suggestions include:

• comfort your child – having a barking cough and noisy breathing often frightens children, and being scared makes the situation worse
• offer frequent drinks unless your child has difficulty swallowing
• give paracetamol or ibuprofen according to the directions on the packet. If your child has a high fever, ensure your child is seen by a doctor to be sure it isn’t another condition that can look like croup.
• moisture in the air – some parents like to use vaporisers in their child’s room, but doctors do not recommend this as there is no evidence that these help croup, and there is a risk of burns from the steam.

By a doctor

Mild croup usually settles within a couple of hours and the child will go back to sleep. If the croup doesn’t settle, or if your child becomes more distressed or unwell, take them to the nearest Emergency Department or a doctor that can treat children straight away. Medical treatment for croup may include:

• Steroids – oral or inhaled. Steroids help by reducing the inflammation of the airway. They decrease the length of the croup episode, and the need for admission into hospital.
• Nebulised adrenalin – in severe symptoms, adrenalin may be given in a hospital to relieve swelling in the windpipe until the steroids work. A nebuliser is a device that looks like an oxygen mask, and delivers the medication in a mist form into the lungs.

As croup is caused by viruses, antibiotics will not work to make your child better, as antibiotics are only useful against bacteria.

It is usually not possible to prevent croup, as many of the viruses that cause croup do not have vaccinations. However, the influenza vaccine is recommended as this may actually prevent croup caused by the influenza virus.