Croup is usually a childhood illness. It is a respiratory condition that affects the windpipe – or trachea, the airways – or bronchi and the voice box – or larynx. It is also called laryngo-tracheo-bronchitis. When a child has croup, it causes swelling within the voice box and the windpipe can become blocked. This causes breathing difficulties.
Causes of croup
Croup generally develops because of a viral infection. The most common cause is the parainfluenza virus, which is airborne so that children can become infected by being in contact with other people who have the virus, and by breathing in the tiny droplets that are emitted when an infected person coughs or sneezes. Other viruses that can cause a child to develop croup include Influenza A and B, which are common flu viruses, the measles virus in children who have yet to be immunised, the rhinovirus which causes the common cold and the respiratory syncytial virus, which can be responsible for pneumonia.
In rarer cases there may be another factor that causes croup to develop such as a child accidentally inhaling a small object or certain irritant chemicals. It is also possible to develop croup as a result of an allergic reaction, such as hay fever or sensitivity to dust mites, or even because of acid reflux, meaning that stomach acid is leaking back into a child’s throat.
Signs and symptoms
Croup is generally more common during the autumn and winter months that are known as ‘cold and flu season’. It often begins with typical cold-like symptoms such as a fever and a runny nose. The main signs that a child has developed croup are:
- Breathing difficulties
- A child’s voice sounding hoarse
- A distinctive cough that sounds like barking
- Stridor, meaning a grating sound that can be heard when a child breathes in, that is especially noticeable when they are crying or coughing.
Croup symptoms are usually worse at night, and will generally last for a few days, although it can be longer in some cases.
Diagnosis and treatment
Croup should be diagnosed by a GP who can also check that there are no serious complications. The doctor may do a general examination by checking for a fever, listening to the child’s chest and looking in their ears and throat. They may also do a pulse oximetry test using a small device that is briefly clipped to the child’s finger to check the levels of oxygen in their bloodstream.
Common complications surrounding croup include dehydration, as children may struggle to take fluids. Children with croup are also at risk of developing a secondary infection such as pneumonia.
Most children with croup will be treated at home. Paracetamol or ibuprofen can be given to ease fever and discomfort, and it is important to give plenty of fluids. A dose of steroid medication may be prescribed to reduce the inflammation behind the breathing difficulties.
Symptoms can worsen and become serious quickly, so it is important to be aware and to go to the nearest accident and emergency department immediately if any of the following occur:
- Extreme or worsening breathing difficulties
- Very rapid breathing and breathlessness
- Drowsiness or difficulty in waking or rousing
- The skin under the child’s ribs being visibly pulled inwards as they breathe. This is a sign of breathing distress and the chest muscles having to work harder than they should
- The child looking blue
- A soaring temperature
- The child being unable to take fluids
- A barking cough or stridor getting worse
There are several serious and even potentially life-threatening underlying conditions that can cause breathing difficulties and can seem a lot like croup, so the GP may need to rule these out. They include:
- Epiglottitis, meaning inflammation of the epiglottis, which is the flap below the tongue that normally prevents food from entering the windpipe. The symptoms can seem very like croup, so it is important to seek help to rule out this condition if a child has any of the above symptoms.
- A foreign body such as a peanut that has been accidentally inhaled
- A severe allergic reaction
- An abscess in the throat.