When you have children, colds and coughs are part of the territory. Most parents know younger children will get through the common colds and viruses going around. Many parents are concerned, though, when what seems to be a normal cold starts to sound much worse and their child wakes up struggling to breathe, and has a barking cough. In this case, it’s likely their child has croup.

While the so-called stridor (noisy breathing) sounds terrible, croup in young children is actually very common and is mostly treatable at home.

What is croup in children?

Croup is caused by a viral infection that causes inflammation and swelling in the windpipe (trachea) and the vocal cords (voice box). The infection is most commonly caused by the human parainfluenza viruses, but there are several other respiratory viruses that can cause viral croup.

Only about one in 10 children who get these respiratory viruses will develop viral croup.

Children have much smaller airways than adults, which is why croup is rarely seen in adults, whose larger airways can cope better with inflammation. A child’s breathing might be affected to different degrees.

What are the croup – symptoms?

Croup usually begins with mild symptoms in the upper airway. They are like those of like any normal cold – a runny nose, sore throat, fever, and lethargy – but then the child develops further symptoms:

Loud, harsh, barking cough, usually worse at nighttime
Hoarse voice
Difficulty swallowing
Labored or noisy breathing, especially when inhaling (stridor); it makes a wheezing sound, like a high-pitched whistle or squeak.

What to do about croup – treatment?

Most cases of croup are mild and don’t require any medical treatment. Mild croup is when your child has the barking cough but no stridor or difficulty breathing.

There are ways you can treat croup at home:

Offer lots of comfort, as children can become frightened and upset if they find breathing difficult or have a barking cough
Keep your child calm and quiet, as being upset or too active can make breathing more difficult
Treat cold symptoms by providing comfort, as needed
Make your child comfortable if he has a fever. You can read more about treating fever in Fever Phobia – What’s The Best Way To Treat A Fever?
Offer plenty of fluids, which will help avoid dehydration, if there is a fever, and also soothe a sore throat
Make sure your child has plenty of rest, as the nighttime waking might disrupt sleep for a few nights. It can help to share a room, so your child is less likely to become upset.

An old home remedy was the use of steamy warm air from a device such as a vaporizer; research hasn’t shown any benefits from this treatment. If you try warm steam therapy, make sure your child is not at risk of burns from hot water.

Some parents swear by wrapping children very warmly and taking them into the cold night air. This is said to reduce the inflammation in the throat and improve breathing.

Is croup dangerous?

Croup is a very common illness in babies, toddlers, and preschool-aged children. It usually lasts for a few days and then disappears. Some children get the condition several times. Babies should be watched carefully for more severe symptoms of croup.

In the most severe cases of croup, it is important to seek medical help at the nearest emergency department. Severe croup won’t be missed.

Some of the most common croup symptoms to look for are:

Difficulty in breathing. When your child has trouble breathing he needs immediate medical attention. Call the emergency medical services
The skin between the ribs is pulled in with each breath
A blue or gray color around the mouth, nose, or fingernails. This is a sign your child isn’t getting enough oxygen
Extreme irritability
Signs of dehydration and extreme lethargy
Drooling and difficulty swallowing.

Medical breathing treatment for croup can include steroids or adrenaline. Steroids relieve the symptoms of croup by reducing inflammation. Adrenaline may be given in some cases, to relieve the swelling very quickly until the steroids can work. A nebulizer is used to give adrenaline as a mist, which is then inhaled.

How to avoid croup

It is hard to avoid croup as it is so common among children up to the age of five. As with any contagious virus, your child can be exposed by being in contact with another infected person who has cold symptoms, or by touching something the other person has touched. Viruses can survive on surfaces for some time.

The best way to prevent croup is to avoid anyone who is obviously unwell with a cold. Encourage your children to wash their hands to minimize infection and, if they become unwell, make sure they stay home, to avoid passing on the virus. Children who have a history of croup will usually grow out of it, as it is partly related to the size of their airways.

How do you get croup?

Croup is contracted by direct contact with the air droplets or body fluids from other people with croup.

It starts affecting the nose and throat (resulting in a runny nose and sore throat) before it travels down to the lungs.

Mild croup can be confused with a common childhood illness, such as a cold; therefore, it’s very difficult to avoid contact with other children with croup.

Croup usually lasts between three and seven days. Days two and three are usually the days when the child’s symptoms tend to be more severe.

Risk factors of croup in children

Although croup has been well researched, not much light has been shed upon the risk factors.

Research shows, however, that it affects children more than adults, due to the size of their larynxes.

A family history of croup and also having suffered from it previously (recurrent croup) can make the child more predisposed to be affected by croup.

Why does croup get worse at night?

Although a spasmodic croup cough can happen at any time of the day, it’s usually at night when the child’s cough stridor tends to get worse. This is because at night our steroid levels decrease significantly and this makes the swelling of the voice box (larynx) worse.

What is the correct treatment for croup?

Croup treatment will depend significantly on how your child’s croup affects him.

Mild cases of croup might require just symptomatic treatment (treating croup symptoms individually); the most severe cases of croup might require hospitalization.

When your child’s croup symptoms need intervention, stay calm and try to make his breathing easier.

Is steam good for croup?

Breathing water steam almost always helps reduce the swelling of the larynx. Have your child breathe the steam for a few minutes. If, after 10 minutes, the whistling sound or the cough doesn’t improve, then change strategy and get your child to breathe cool air.

Depending on the season or the viability of getting very cold air to breathe, you can open the freezer and have your child take a few deep breaths there. Although cool air will not necessarily help with the cough, it will help with the amount of oxygen that gets into your child’s lungs.

Hot air takes up a lot of space (that’s the rationale behind a hot air balloon: hot air expands, grows, and needs more space). When you’re short of breath, breathing very cold air (condensed air) will maximize the amount of air, and therefore oxygen, you take in with each breath.

Parents of children with recurrent croup tend to run a bath or shower with very hot water and take the child inside the bathroom. Breathing in steam is usually the best and quickest remedy to improve their child’s breathing.

Nebulizer treatment for croup

When more conservative treatment hasn’t worked, steroid medicine usually solves the breathing problems croup can cause. Most cases involving breathing problems in children that are seen in emergency departments are treated with a steroids nebulizer. It reduces the swelling in the child’s airway and restores normal breathing after a couple of minutes of breathing on the nebulizer.

Can you treat croup without steroids?

The use of steroids is a worry for many parents.

This is understandable, especially if your child suffers from recurrent croup and you don’t want your child to be treated with steroids often.

Croup treated with steroids resolves easily and fast; however, steroids shouldn’t be taken lightly.

First, try the treatments we suggested earlier. Use steam and cold air-breathing to help relieve your child’s symptoms of croup. You can leave the use of steroids for severe croup when other more gentle methods have not resolved your child’s condition.

You can find more information in Croup In Babies – Is Croup Contagious?