Croup often begins as a typical cold. If there is enough inflammation and coughing, a child will develop a loud barking cough. This often is worse at night, and is further aggravated by crying and coughing, as well as anxiety and agitation, setting up a cycle of worsening symptoms. Fever and a hoarse voice are common, too. Your child's breathing may be noisy or labored.
Because children have small airways, they are most susceptible to having more marked symptoms with croup, particularly children younger than three years old.
Nighttime croup symptoms of labored breathing can often lead concerned parents to bring their child to the emergency room.
Symptoms of croup usually last for three to five days.
When to see a doctor
Less than 5 percent of children develop airway obstruction serious enough to require hospitalization. You should seek immediate medical attention if your child:
- Makes noisy, high-pitched breathing sounds (stridor) both when inhaling and exhaling
- Begins drooling or has difficulty swallowing
- Seems anxious, agitated or fatigued
- Breathes at a faster rate than usual
- Struggles to breathe
- Develops blue or grayish skin around the nose, mouth or fingernails (cyanosis)
Croup is usually caused by a virus infection, most often a parainfluenza virus.
Your child may contract a virus by breathing infected respiratory droplets coughed or sneezed into the air. Virus particles in these droplets may also survive on toys and other surfaces. If your child touches a contaminated surface and then touches his or her eyes, nose or mouth, an infection may follow.
The infection usually starts in the nasal membranes and then spreads to the vocal cords (larynx) and windpipe (trachea). Only a small percentage of exposed children actually develop croup.
Most at risk of getting croup are children between 6 months and 3 years of age. The peak incidence of the condition is 18 to 24 months of age.
Most cases of croup are mild. In a small percentage of cases, the airway swells enough to interfere with breathing.
To prevent croup, take the same steps you use to prevent colds and flu. Frequent hand-washing is most important. Also keep your child away from anyone who's sick, and encourage your child to cough or sneeze into his or her elbow.
To stave off more-serious infections, keep your child's vaccinations current. The diphtheria and Haemophilus influenza type b vaccines offer protection from some of the rarest — but most dangerous — forms of upper airway infection.