Your baby is coughing and you are concerned. Could it be a simple cold or is it the flu? RSV? COVID-19?

It may be croup. Croup is known for its distinctive “barking” cough, which is often referred to as “croup cough.” Croup is often seen from October through March, during winter and spring months. It occurs most often in children 3 months to 5 years of age, but the virus can infect older children as well. Most cases of croup are not serious. However, a severe case can result in hospitalization. Babies who are born prematurely are most at risk for complications.

Causes of Croup:

The most common cause of croup is an infection from the human parainfluenza viruses (HPIVs). HPIVs are airborne viruses, typically spreading from an infected person’s cough or sneeze, or when your child touches a contaminated surface or item and then touches their mouth or nose. Other viruses causing croup include:

Adenovirus
COVID-19
Enteroviruses
Influenza A (the flu)
Influenza B (the flu)
Parainfluenza
Respiratory syncytial virus (RSV)

The barking “croup cough” is caused by inflammation of the upper trachea as a result of the virus. Croup (laryngotracheobronchitis) causes inflammation in the voice box (larynx) and windpipe (trachea). This causes the airways just below the vocal cords to swell and become more narrow, which not only makes breathing more difficult, but also produces the tell-tale barking sound when your child coughs.

While the Covid-19 Omicron variant has been connected with increased reports of croup in children, as noted above, croup is most often caused by the parainfluenza virus.

One and done?

Hopefully, your child will not contract croup or will only experience it once. However, some children may experience recurrent episodes of croup. If so, Dr. Leung may refer you to a pediatric otolaryngologist (ENT doctor) for an extensive evaluation of your child’s upper airway, as structural abnormalities can be a cause of recurrent croup.

Croup symptoms

Croup is often misidentified as a cold in the beginning due to the common symptoms of runny nose, fever, and irritability. However, after a few days, your baby’s cough or cries may begin to sound hoarse, followed by the arrival of the barking cough. This is sometimes accompanied by labored or noisy breathing, and can include a high-pitched squeaky sound produced when your child inhales. This is called stridor.

Symptoms of croup:

Barking cough that sounds like a seal (usually worse at night)
Difficulty swallowing
Fever (sometimes)
Hoarse, raspy voice
Irritability
Shortness of breath
Stuffy or runny nose

If your child has symptoms of croup, please call Entirely Kids Pediatrics for an appointment.

How is croup diagnosed?

Dr. Leung may be able to diagnose croup simply by listening to your baby’s cough and performing an examination. However, more tests may be needed if another illness, such as pneumonia or COVID-19, is suspected.

These tests include:

COVID test
Neck or chest X-rays
Blood tests
Pulse oximetry

Is croup contagious?

Croup is contagious. Your child (and you) can become exposed by direct contact with an infected person or to germs on a surface or object. Croup is usually contagious for three days after symptoms start or until the infected person is without a fever. If you or your child contract croup, plan on at least a three-day break from daycare, preschool, family plans, or other activities.

How long does croup last?

Croup in children generally lasts from several days up to a week.

Treatments for croup in babies and toddlers

Mild cases of croup will resolve by themselves and can be managed at home. Antibiotics are not needed to treat croup, as croup is almost always caused by a virus, not a bacteria. The following will usually help relieve your baby’s discomfort:

Steam: take your child into the bathroom, get a hot shower running, and close the door. Then stand together in the steamy bathroom (not in the shower itself) for 15 to 20 minutes. The warm moist air helps reduce inflammation in the airways and make breathing easier for your child.
Night air: if the temperatures are cool, take your baby outside into the fresh air for 15 minutes. You can also open the freezer door and have your little one breathe in the cool air for several minutes.
Humidifier: a cool-mist humidifier can be run in your baby’s room at night. Use filtered or distilled water and be sure to clean it daily with a bleach-and-water solution.
Stay upright: try to keep your baby in an upright position when awake, as it will make it easier for your child to breathe. You can also try putting your baby in a high chair or another seat. However, during naptimes and at night, avoid the use of pillows or other items designed to help your child’s head stay elevated, as they can be dangerous.
Avoid dehydration: provide your child with lots of fluids to soothe the throat. Breastfed babies under 6 months old can be given frequent feedings. Breastfed babies over 6 months of age can be given more frequent feedings in addition to sips of water. For formula-fed babies under 6 months, offer the usual amount of formula in smaller, frequent feedings. Do the same for those over 6 months along with sips of water between feedings. For babies and toddlers over 1 year, offer water or a rehydration fluid like Pedialyte, in smaller, more frequent amounts.
Comfort: crying can make breathing difficulties worse. Comfort your child as much as possible to keep them calm.
Honey: never give honey to babies under 1 year. If your little one is over 12 months, give 1 teaspoon of honey before bedtime to help ease their throat from the coughing.
Fever: if your little one has a fever, check with Dr. Leung about giving acetaminophen (Tylenol) to bring it down.

Croup Prevention

Because croup is airborne or spread by contact with contaminated surfaces, it’s important to practice good hygiene. Wash your little one’s hands after blowing his nose, coughing, or sneezing. Use an alcohol-based hand sanitizer if soap and water are not available. If your child is a toddler, teach them to cover the mouth and nose when coughing or sneezing by doing the “vampire” cover (the inside of the elbow) or by using a tissue. Since your baby’s immune system is vulnerable to all sorts of germs, ask friends or relatives to postpone visits to your house if they are under the weather.

Because the influenza virus can sometimes cause croup, it is possible for a flu shot to reduce the chance of croup infection. The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend a flu vaccine every year for all children 6 months and older. Kids older than 5 can also choose to receive the COVID-19 vaccine. A vaccine against parainfluenza viruses, the most common croup-causing viruses, is not currently available. However, young infants do have protection against some types of parainfluenza because of antibodies from their mothers.

When should I contact the doctor?

Be sure to get in touch with our office if you note any of the following:

Steam or cold air does not help the barky coughing or stridor
Your baby looks pale or there is a bluish or grayish hue around your child’s mouth, nose, or fingernails
You hear stridor during the day
Your child appears to have difficulty catching their breath, especially during the day
You see the skin between the ribs pulling in with each breath, which are called retractions
Your baby has symptoms of dehydration (like crying without tears and fewer wet diapers)

If you suspect croup in your baby or toddler, call Entirely Kids Pediatrics for an appointment. You know your child best, so trust your instincts if you have concerns. If your baby is having trouble breathing, has pale or blue skin or lips, or seems drowsy or hard to wake up, call 911 or take him to the emergency room immediately.

What You Should Know About Croup