Viral croup; Laryngotracheobronchitis; Spasmodic croup; Barking cough; Laryngotracheitis
Croup is an infection of the upper airways that causes breathing difficulty and a "barking" cough. Croup is due to swelling around the vocal cords. It is common in infants and children.
Croup affects children ages 3 months to 5 years. It can occur at any age. Some children are more likely to get croup and may get it several times. It is most common between October and April, but can occur at any time of the year.
Croup is most often caused by viruses such as parainfluenza RSV, measles, adenovirus, and influenza. More severe cases of croup may be caused by bacteria. This condition is called bacterial tracheitis.
Croup-like symptoms may also be caused by:
The main symptom of croup is a cough that sounds like a seal barking.
Most children will have mild cold and low grade fever for several days before having barking cough and a hoarse voice. As the cough gets more frequent, the child may have trouble breathing or stridor (a harsh, crowing noise made when breathing in).
Croup is typically much worse at night. It often lasts 5 or 6 nights. The first night or two are most often the worst. Rarely, croup can last for weeks. Talk to your child's health care provider if croup lasts longer than a week or comes back often.
Your provider will take a medical history and ask about your child's symptoms. The provider will examine your child's chest to check for:
An exam of the throat may reveal a red epiglottis. In a few cases, x-rays or other tests may be needed.
A neck x-ray may reveal a foreign object or narrowing of the trachea.
Most cases of croup can be safely managed at home. However, you should call your provider for advice, even in the middle of the night.
Steps you can take at home include:
Your provider may prescribe medicines, such as:
Your child may need to be treated in the emergency room or to stay in the hospital if they:
Medicines and treatments used at the hospital may include:
Rarely, a breathing tube through the nose or mouth will be needed to help your child breathe.
Croup is most often mild, but it can still be dangerous. It most often goes away in 3 to 7 days.
The tissue that covers the trachea (windpipe) is called the epiglottis. If the epiglottis becomes infected, the entire windpipe can swell shut. This is a life-threatening condition.
If an airway blockage is not treated promptly, the child can have severe trouble breathing or breathing may stop completely.
Most croup can be safely managed at home with telephone support from your provider. Call your provider if your child is not responding to home treatment or is acting more irritable.
Call 911 right away if:
Some of the steps to be taken to prevent infection are:
James P, Hanna S. Upper airway obstruction in children. In: Bersten AD, Handy JM, eds. Oh's Intensive Care Manual. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 106.
Rodrigues KK, Roosevelt GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 412.
Rose E. Pediatric respiratory emergencies: upper airway obstruction and infections. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 167.
Yellon RF, Chi DH. Otolaryngology. In: Zitelli BJ, McIntire Sc, Nowalk AJ, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 24.BACK TO TOP
Review Date: 1/1/2020
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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