Croup Common Respiratory Illness in Children

Overnight ‘Barky’ Cough is often a Symptom

The respiratory tract seems to be more prone to illness in the fall and winter months. Different illnesses affect different portions of the respiratory system. Croup is a respiratory illness that causes inflammation and swelling of the upper portion of the trachea and larynx and is known for its characteristic cough. The cough sounds like a seal barking.  

Croup affects children between 6 months and 3 years old (although older children can be affected). It is primarily a viral illness that can be caused by different viruses but most commonly by a family of viruses known as parainfluenza viruses. There is no vaccine for parainfluenza viruses.

Young children are more susceptible to this problem because the diameter of the upper airway (trachea and larynx) is small. The virus tends to cause swelling just below the vocal cords. Since the opening to the airway is naturally small at this point, a small amount of swelling can cause significant narrowing. This causes the barking cough and can cause difficulty getting air to flow adequately.  When adults (with larger diameter airways) become infected with the same virus, they tend to have just cold symptoms since the swelling does not cause significant narrowing of their airway.

Interestingly, croup tends to be a night-time illness. It is common for children to go to bed with very minimal symptoms and then wake during the night with cough, hoarseness, low grade fever and trouble breathing. The wind pipe can be narrowed enough that breathing can make a noise as air passes through this area. This is known as stridor.

Another interesting characteristic of croup is that parents often get frightened by the symptoms and bring the child to the emergency department and then feel embarrassed because the child is doing better when they arrive. This is because they go out in the cool night air and this has the effect of decreasing the swelling of the tissue lining the airway so that air flows more effectively.

Croup generally gets better on its own. Antibiotics do not help with viral infections. Croup tends to come on rapidly and slowly resolve. The symptoms can be helped by breathing cool moist air, by wrapping the child in a blanket and going outdoors. Another technique is to go into the bathroom with the door closed and the hot water on so the room gets steamy.  A cool mist vaporizer in the room can also help.

Indications that a child would need to seek medical care would be difficulty breathing, retractions of the chest with breathing, making noise from the upper airway when breathing in and out, drooling due to inability to swallow, lethargy or turning bluish color around the face. Children should be able to take in liquids by mouth. Generally clear liquids, but whatever they will take is OK.

In severe cases, treatment with oxygen, inhaled medication and/or steroid medication may be indicated. In the most severe cases, a tube may be put into the wind pipe to keep it open.

Careful hand washing, covering the mouth and nose with a cough or sneeze and avoiding people with respiratory illness can help protect children from croup. Also childhood vaccination against influenza, diphtheria, pertussis, MMR and Haemophilus Influenza B (HIB) can prevent croup-like illness. HIB has been associated with a serious bacterial infection that can mimic croup known as epiglottitis which fortunately is relatively rare due to widespread vaccination.

Croup is a common condition identifiable by the characteristic barking cough. Fortunately, it resolves on its own in most cases but may need medical attention if respiratory distress occurs.

Michael Shattuck, MD, is an emergency department physician at ThedaCare Medical Center-Berlin.