Like some other childhood viral infections—such as roseola, which causes a fever followed by a rash, or fifth disease, which causes a bright-red rash on the cheeks—croup has distinctive symptoms and is generally easy to recognize. There’s no formal test for croup. Your child’s pediatrician will most likely diagnose it based on the presence of certain telltale symptoms.
Symptoms of Croup
Children with croup are usually about 6 months to 6 years old, have a few days of low-grade fever, cough, runny nose, and then suddenly—typically in the middle of the night—develop:
A bark-like cough A hoarse or raspy voice Continued fever, which can be low-grade or up to 104 degrees Fahrenheit, although some kids with croup don’t have any fever at all Difficulty breathing and inspiratory stridor: This harsh, loud, high-pitched noise that kids with croup can make when they take a breath may be confused with wheezing.
If your child has croup, the symptoms are likely to be worse at night, when they’re agitated and better during the day, when they calm down. Symptoms can also get better when your child is exposed to cool air, which explains why many children get better on the way to the emergency room.
Severity of Croup
Most cases of croup are mild and go away when treated with home remedies. However, depending on how difficult it is for them to pull air into their lungs, some children have more severe symptoms and need immediate medical attention. Here’s what you need to know:
Mild Croup
Kids with mild croup are alert and don’t have a bluish discoloration of their skin or nails (cyanosis), which means their blood is supplying enough oxygen. They also don’t have retractions, which is sucking in of the skin around the ribs and the top of the sternum (breast bone). They may have a barking cough. Stridor isn’t present when they’re resting but it may occur as they cough or cry. Mild croup can become more severe intermittently throughout the course of the illness, especially during the evening hours.
Moderate Croup
Children with moderate croup may have stridor and retractions at rest, may be slightly disoriented or agitated and may have moderate difficulty breathing.
Severe Croup
Retractions are a sign of severe croup, and a child with severe croup has stridor and retractions at rest. These include an inward movement of the sternum or skin between the ribs as the child struggles to take a breath. He or she may appear anxious, agitated, or fatigued. Cyanosis is common when the child is moving or crying, but then progressively worsens and becomes noticeable even when the child is resting.
Croup vs. a Cough
Croup produces a very distinct cough, said to sound like a barking seal. If you’re not sure what that sounds like, you can search for “croup cough” videos on YouTube to get a better idea. A croupy cough sounds much different than any another cough your child will have with a cold, asthma, or bronchitis. The distinctive cough occurs as the infection progresses from the nose and throat to the windpipe, and the space available for air to enter the lungs narrows.
Treatment for Croup
If your child has croup, your doctor may prescribe a steroid to help reduce any inflammation in his or her airway. A child with a severe infection may need to be hospitalized. At home, you can make your child more comfortable by setting up a humidifier or sitting him in a bathroom (not in the shower) filled with steam generated by running water from the shower. If they’re agitated, try and remain calm as to better help them relax—anxiety can worsen symptoms. Fluids and fever reducers can help manage symptoms as well.
Tips for Preventing Croup
Croup is caused by a virus, so it can spread through coughing and sneezing as well as by dirty hands, sharing toys, and sharing drinking glasses or utensils. To help prevent croup, the American Academy of Family Physicians recommends that you:
Ask people with a cough to avoid kissing or playing with your child. Make sure everyone in your house washes their hands often. Throw away dirty tissues from runny noses and sneezes right away. Wash toys in hot soapy water if a sick child has had them in his or her mouth.
