Croup: What Parents Need to Know to Breathe Easier

You are sound asleep. Suddenly, a barking dog wakes you up. But you don’t have a dog. The “barky” cough of croup is notorious for coming on abruptly, often without warning, in the middle of the night. It can be frightening for both parents and children. Fortunately, in most cases, the bark is typically worse than the bite!

What is Croup?

Croup is a viral illness that triggers swelling of the larynx and trachea. Those are just fancy words for the voice box and windpipe. A distinctive barking cough and/or high-pitched, “crowing” noise (which we call stridor) happens when air is forced against a constricted airway during a breath in or a cough. The smaller the child, the more prominent the sound.

It primarily affects infants and children, between the ages of 6 months and 3 years of age. It peaks around 24 months of age. As children grow, so do their airways. Therefore, children above the age of 6 are rarely diagnosed with croup.

Here’s a video of what the cough sounds like:

What Are the Symptoms of Croup?

Symptoms progress as the virus travels from the nose to the throat and eventually reaches the upper respiratory tract. The first symptoms you may notice in your child are a common cold such as a runny nose, a hoarse voice, and fever. The telltale barky cough sets in after 1 to 2 days of cold symptoms. You may ask yourself – when did my sweet toddler turn into a barking seal?

The stories are all very similar – the child who was once well-appearing goes to bed and wakes suddenly in the middle of the night with a harsh cough and difficulty breathing. By the morning, symptoms often improve, and you think your child may be in the clear. Unfortunately, as most parents who have cared for a child with croup will tell you, the symptoms often reappear in full force the following night. This is common in croup, as the cough peaks on night 2 or 3 and then progressively improves. The good news is that symptoms of croup are usually mild and typically resolve in a week.

How do you know if my child has mild vs. moderate-to-severe symptoms of croup? Below is a cheat sheet that differentiates characteristics of children with mild, moderate, and severe croup. Parents can often manage mild croup at home, while a medical provider needs to evaluate moderate and severe croup.

Croup Severity Cheat Sheet

	Behavior	Barky Cough	Chest Wall Retractions	Stridor
Mild Croup	No agitation	Occasional barky cough	Either no or mild retractions	No stridor at rest (may be present when upset)
Moderate Croup	Little or no agitation	Frequent barky cough	Mild-to-moderate retraction	Stridor at rest
Severe Croup	May appear anxious, agitated, or pale and fatigued	Frequent barky cough	Severe/marked retractions	Stridor at rest

Is Croup Contagious?

Yes, croup is contagious. Kids get it by breathing in airborne droplets. That means one person can pass it to another through coughing, sneezing, and close contact. Frequent hand washing with soap and water is the single most important tool in infection control – a few seconds at the sink can save you a trip to the doctor’s office.

Children are contagious for 3 days after the onset of the illness or until the fever has subsided.

Is Croup Contagious?

There are some benefits of being an adult. One of them being that our airways are approximately 4x the size of an infant’s in diameter. What does that mean in layman’s terms?

Pull out your wallet and compare a dime to a quarter – which is larger? Obviously the quarter! Think of the dime being the size of an infant’s airway, while the quarter is the size of an adult’s airway – minimal swelling of the larynx/trachea will have a much more dramatic impact on an infant’s airway than an adult’s. While inflammation of an infant’s and child’s upper airway may lead to the trademark barky cough, stridor, and difficulty breathing, adults are much more likely to have symptoms of common cold and hoarse voice or laryngitis.

Basically, kid airways are floppy. Adult airways are more rigid and, thus, less likely to close up when irritated and swollen.

What to Do to Make Your Child More Comfortable

Croup can be successfully managed at home for most children. Here are a few tips that can help ease your child’s breathing:

Try to remain calm. If your child sees that you are upset, it will likely increase his/her anxiety and lead to crying which can cause labored breathing.

At nighttime, stay in close proximity to your child. That way you can comfort and monitor them.

Cool, humid air seems to do the trick. If you don’t have a cool-mist humidifier at home, please don’t run to the store in the middle of the night to buy one. If it is a cool night, cover your child in a blanket and take him/her outside to breathe in the cold air. You could even open the freezer and have your child breathe in the cold air! Just remember, kids can’t get sick from being outside. They won’t “catch pneumonia,” if you take them outside to breathe soothing cold air.

Keep your child’s head elevated. Prop an extra pillow under your child’s head while he is in bed or place your infant in her car seat. Do not use pillows with infants younger than 12 months of age.

Encourage warm or cold, clear fluids. Fluids help loosen mucus on the vocal cords, soothe a sore throat, and ensure the child stays hydrated.

If your child has a fever (100.4F), you can give acetaminophen (Tylenol) or ibuprofen (Motrin) > 6 months. Use KidMed Urgent Care’s dosing chart for Tylenol and Motrin, based on your child’s weight.

What to NOT to Do

Do not give your child over-the-counter cough or cold medicines. A cough is a protective reflex that aids in clearing secretions or irritants from your throat and airway.

Avoid smoking in the home or around the child. Smoking can make your child’s cough worse.

KidMed Urgent Care is here if you need us!