Croup

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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W8MD medical weight loss NYC and sleep center NYC

Croup
The steeple sign as seen on an X-ray of the neck, indicative of croup.
Synonyms	Laryngotracheobronchitis
Pronounce	N/A
Specialty	N/A
Symptoms	Barking cough, stridor, hoarseness, fever
Complications	Respiratory distress, bacterial tracheitis, pneumonia
Onset	6 months to 5 years old
Duration	1–2 days
Types	N/A
Causes	Viral infection (e.g., parainfluenza virus)
Risks	Seasonal variation (more common in fall and winter)
Diagnosis	Based on clinical presentation
Differential diagnosis	Epiglottitis, bacterial tracheitis, foreign body aspiration
Prevention	Hand washing, influenza vaccination
Treatment	Corticosteroids, nebulized epinephrine
Medication	Dexamethasone, budesonide
Prognosis	Generally good with treatment
Frequency	Common
Deaths	Rare

Croup is disease of infants and young children; harsh coughing and hoarseness and fever and difficult breathing.

Croup steeple sign

Clinical features

Croup is a pediatric respiratory illness that primarily affects infants and young children. Characterized by a harsh, barking cough, hoarseness, fever, and difficulty breathing, croup is most commonly caused by viral infections, particularly the parainfluenza virus. Treatment generally involves supportive care, with more severe cases requiring medical intervention.

Symptoms

Croup typically presents with the following symptoms:

• Harsh, barking cough: The most distinctive symptom of croup, often described as sounding like a seal's bark.
• Hoarseness: Children with croup may have a hoarse voice due to inflammation of the larynx (voice box).
• Fever: A low-grade fever is common in cases of croup.
• Difficulty breathing: Inflammation and swelling of the airways can cause noisy, labored breathing, known as stridor. This symptom is more prominent during inhalation and can worsen when a child is agitated or crying.

Symptoms typically worsen at night and can last for several days.

Causes

The primary cause of croup is viral infections, with the most common causative agent being the parainfluenza virus. Other viruses that can cause croup include:

• Respiratory syncytial virus (RSV)
• Influenza virus (flu)
• Adenovirus
• Enterovirus
• Rhinovirus (common cold)

Croup is contagious and can spread through respiratory droplets from coughing or sneezing, as well as contact with contaminated surfaces.

Diagnosis

Croup is typically diagnosed based on the child's symptoms and a physical examination. A physician may listen to the child's breathing, examine the throat, and assess vital signs. In some cases, additional tests may be performed to rule out other respiratory conditions, such as:

• Chest X-ray
• Blood tests

Treatment

Treatment for croup is primarily focused on providing supportive care to help manage symptoms and make the child more comfortable. In most cases, croup can be treated at home with the following measures:

• Hydration: Encourage the child to drink plenty of fluids to prevent dehydration.
• Humidity: Use a cool-mist humidifier or have the child breathe in steam from a hot shower to help alleviate airway inflammation and ease breathing.
• Comfort: Keep the child calm and comfortable, as agitation or crying can worsen symptoms.

In more severe cases or when home treatment is not effective, medical intervention may be necessary. Treatment options in such cases may include:

• Steroids: Oral or inhaled corticosteroids may be prescribed to help reduce airway swelling and improve breathing.
• Nebulized epinephrine: In cases of severe respiratory distress, a doctor may administer nebulized epinephrine to help open the airways.
• Oxygen therapy: If a child is experiencing significant difficulty breathing, supplemental oxygen may be provided.

Prevention

To reduce the risk of croup, it is essential to practice good hygiene and follow basic infection control measures, including:

• Handwashing: Frequent handwashing with soap and water or using an alcohol-based hand sanitizer can help prevent the spread of infection.
• Cough etiquette: Teach children to cover their mouths when coughing or sneezing to prevent the spread of respiratory droplets.
• Vaccination: Although there is no specific vaccine for the parainfluenza virus, getting vaccinated for other respiratory illnesses, such as the flu, can help reduce the risk of croup.
• Avoiding close contact: Limit close contact with infected individuals and keep children away from others who are sick.

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