Baby Advice : Croup

Croup is a disease that affects children from around 3 months to 6 years old, and is most common in those under 3 years old. Its main distinguishing feature is a harsh barking cough. Croup usually lasts for three to seven days.

Causes and Symptoms

Croup (laryngotracheobronchitis or laryngotracheitis) is an upper airway infection that small children are susceptible to because of the shape and size of their airways. Their body’s reaction to this infection is what brings about the coughing and other respiratory symptoms. This is why older children and adults reaction to such an infection results merely in a sore throat or laryngitis. The disease is very often caused by parainfluenza virus, but sometimes by other viral and bacterial infections. There may also be hereditary factors at work in some families that can increase the likelihood of susceptibility. Some symptoms of croup are:
• A barking cough similar to the sound a seal makes.
• Stridor, a high pitched sound heard on inhalation.
• Fever.
• Hoarseness of voice.
The onset of croup is quite rapid and often occurs after the child has a cold. Most cases of croup happen in the winter and early spring. Symptoms tend to worsen at night. Although cases are often mild, in severe cases of croup the breathing difficulties characterised by stridor are noticeable even when the child is sleeping or at rest. Some other signs of severe croup are shortness of breath, bluishness around the mouth, drooling and visible evidence, around the neck area and below the ribcage, of straining to breathe. Such signs are an indication of the need for urgent medical attention. About one in ten children with croup have to go in to hospital.

Prevention and Treatment of Croup

Croup is roughly as contagious as the common cold. It can be transferred by droplets in the air produced by sneezing and coughing, and thence also by touch. A good hand washing regime is therefore important to try to keep it at bay.
There are some treatment methods which parents can try if a child has an attack of croup:
• Use the bathroom as a temporary steam room. Turn on the hot taps or shower and close the door to retain the steam. Sit in the bathroom with the baby. Improvements should be noticeable in ten to fifteen minutes (researchers note while some websites doubt the efficacy of such steam treatment, and advise against it because of the potential for scalding, it must be said that the majority, including the NHS direct website, still endorse it).
• Calm the child. Parents should try to remain calm themselves and reassure the child. Sit the baby on your lap in an upright position. Try playing music, singing or reading. If breastfeeding, it may help to try feeding the child at this time.
• Cool mist. The use of humidifiers or vaporisers may help alleviate an attack of croup. These could also work as a preventative measure installed in the room. Care must be taken to keep humidifiers hygienically clean to avoid mould developing. Hot mist vaporisers can also work, but great care must be taken with these as they could scald the child. Some people find that taking the cool night air with their child can alleviate symptoms.
• For treatment of fever symptoms, paracetamol in a liquid form or ibuprofen can be given to lower the temperature. These are not normally recommended for children under 2 months old. Consult a doctor before giving such drugs to a baby. Aspirin should never be given to any child under 12 years old (some sources advise under 16 or even 18 years old).
• Encourage the child to take extra fluids to combat dehydration.

Antibiotics are not used for treating croup as it is caused by a virus, and antibiotics are not effective against viruses.
Antihistamines and decongestants are not advisable for treating croup as they can dry the airways and worsen the problem. Some over the counter cough medicines may contain such ingredients. Any cough medicines that can cause drowsiness should be avoided when a child has croup and needs strength for breathing. Smokey atmospheres are best avoided.

Other Treatment and Hospitalisation

A doctor may prescribe a steroid medicine for croup. This should ease the symptoms quite quickly, though it will not shorten the overall duration of the condition.
There are warning signs to be aware of that indicate the need for urgent medical attention. Among these are:
• Stridor at rest.
• Rapid breathing.
• Drooling or an inability to swallow.
• Complexion change. A child with croup will often be flushed or pink in colour. A change in complexion to pale or bluish often around the mouth or lips is an indication of severe croup.
• If the child’s condition does not improve after 20 minutes in the improvised steam room, or the fever persists after measures such as administering paracetamol or ibuprofen have been taken.
• If, when the child inhales, the ribs retract.
• If the child shows symptoms of croup but another cause is suspected e.g. a foreign body is blocking the windpipe.
In the event that a child is hospitalised, the procedures undertaken there, range from treatments with steroids and humidified oxygen, to the insertion of a tube into the trachea through the mouth or nose to assist breathing. Fluids may be given intravenously to help prevent dehydration.
Certain conditions can cause complications with croup. Asthma sufferers and those born prematurely are among those who may suffer from more severe breathing difficulties. In rare circumstances there can be allergic reactions to the croup virus, or secondary infections like pneumonia. Overall, however, croup is less dangerous than in days gone by. This is in no small part due to vaccinations for measles, diphtheria and the like, helping protect children from some of the more dangerous forms of the disease.