Croup is a condition that causes a swelling of the voice box (larynx) and windpipe (trachea). The swelling causes the airway below the vocal cords to become narrow and makes breathing noisy and difficult. It is most commonly due to an infection.

Children are most likely to get croup between 3 months and 5 years of age. As they get older, it is not as common because the windpipe is larger and swelling is less likely to get in the way of breathing. Croup can occur at any time of the year, but it is more common in the fall and winter months.

Types of croup
Viral croup

This is the most common type of croup. It is caused by a viral infection of the voice box and windpipe. It often starts out just like a cold, but then slowly turns into a barky cough. Your child’s voice will become hoarse and her breathing will get noisier. She may make a coarse musical sound each time she breathes in called stridor. Most children with viral croup have a low fever, but some have temperatures up to 104°F (40°C).

Spasmodic croup

This type of croup is thought to be caused by an allergy or by reflux from the stomach. It can be scary because it comes on suddenly, often in the middle of the night. Your child may go to bed well and wake up in a few hours, gasping for breath. She will be hoarse and have stridor when she breathes in. She also may have a barky cough. Most children with spasmodic croup do not have a fever. This type of croup can recur. It is similar to asthma and often responds to allergy or reflux medicines.

Stridor is common with mild croup, especially when a child is crying or active. But if a child has stridor while resting, it can be a sign of more severe croup. As your child’s effort to breathe increases, she may stop eating and drinking. She also may become too tired to cough, and you may hear the stridor more with each breath.

Treatment at home

If your child wakes up in the middle of the night with croup, take him into the bathroom. Close the door and turn the shower on the hottest setting to let the bathroom steam up. Sit in the steamy bathroom with your child. Within 15 to 20 minutes, the warm, moist air should help his breathing.  You can also alternate with sitting in front of an open window or stepping outside for a few minutes to let the cool air help decrease the swelling. The barky cough may take longer to improve.  If stridor does not resolve then should be seen in the office or the Emergency Room.

Sometimes another attack of croup will occur the same night or the next. If it does, repeat the steam treatment in the bathroom. Steam almost always works. If it does not, take your child outdoors for a few minutes. Inhaling moist, cool night air may help open the air passages so that he can breathe more freely.  Again, if stridor does not resolve then should be seen in the office or in the Emergency Room.

Treating with medicine

If your child has viral croup and is not breathing better after a steam treatment, your child’s doctor or the emergency department doctor may give your child a breathing treatment with epinephrine (adrenaline) to decrease the swelling. They may also prescribe a steroid medicine to reduce the swelling. Steroids are usually taken by mouth or given by injection. Treatment with a few doses of steroids should do no harm. For spasmodic croup, your child’s doctor may recommend allergy or reflux medicines to help your child’s breathing.

Antibiotics, which treat bacteria, are not helpful for treating croup because it is almost always caused by a virus, or by allergy or reflux. Cough syrups are not useful and may do harm.

When to call the doctor

If you are concerned that your child’s croup is not improving, contact your child’s doctor, local emergency department, or emergency medical services (911) even if it is the middle of the night. Consider calling if your child

Makes a whistling sound while breathing in that gets louder with each breath
Cannot speak or make verbal sounds for lack of breath
Seems to be struggling to catch her breath
Has bluish lips or fingernails
Has stridor when resting
Drools or has extreme difficulty swallowing saliva

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