Croup

What is croup?

Croup is a viral illness, which in young children, causes narrowing of the upper airways. It is more prevalent in autumn and winter. Croup is less common in babies under six months of age or in school age children. Children in these age groups who develop croup should be reviewed by a medical practitioner.

Inflammation and swelling of the lining of the voice box and windpipe cause them to become narrowed. When the airway becomes narrowed, breathing in becomes more difficult and stridor (noisy breathing, with a harsh sound as your child breathes in) is heard. The symptoms of croup seem to most often appear or worsen at night.

Signs and symptoms

• sore throat
• temperature
• red eyes
• runny nose
• poor appetite

Followed by the development of:

• a cough which is often described as ‘barking’
• stridor, which becomes worse when your child gets upset
• hoarse voice.

The stridor may last a few days, but the cough may last for up to a week. Generally croup is at its worst in the first few days of the illness.

How is croup treated?

Croup is caused by a virus so antibiotics do not help. Mild cases of croup can be managed at home and no medication is needed. In moderate to severe croup steroid medication is an effective treatment, which works for about 48 hours.

• If your child becomes upset and distressed, try to calm and comfort the child on your lap to prevent worsening of breathing difficulty and stridor.
• Allow your child to breathe cold air from outside by opening a door or window. Make sure they are warm and don’t get chilled.
• Cool sips of fluid may help sooth a sore throat.
• Paracetamol will help if your child has a sore throat or a fever. Follow the dosage instructions on the bottle as it is dangerous to give more than the recommended dose.

There is no evidence to support the practice of adding steam to the air that the child breathes. In fact there have been instances when the child has received burns from the hot water, so this practice is no longer recommended.

When should I seek urgent help?
If your child has any of the following go to a doctor or the nearest hospital straight away:

• stridor when your child is calm and not upset
• your child is having increasing difficulty breathing
• your child is upset and cannot be consoled
• your child becomes increasingly unwell – pale colour, a very high temperature, cool or clammy hands and feet, dribbling
• you are worried or concerned.

When should I seek emergency help?

Dial 111 for urgent help if your child has any of the following:

• has extreme difficulty breathing or has periods of stopping breathing
• becomes blue
• becomes pale or blue after a coughing spell
• there is a change in their behaviour (become drowsy, agitated or delirious).

For further information on croup visit kidshealth.org.nz.

Sources: Paediatric Society of New Zealand, Starship Foundation and Starship Respiratory Services