Respiratory Syncytial Virus (RSV) is a highly contagious respiratory illness that commonly affects the nose, throat, and lungs of infants and young children. Nearly all children contract RSV by the age of two, though most cases present as a common cold in older individuals. The virus spreads easily through respiratory droplets from coughing or sneezing. Laryngitis is defined by the inflammation and swelling of the larynx, or voice box. When the vocal cords within the larynx swell, it changes the voice quality, often resulting in hoarseness.
Understanding Croup: The RSV-Laryngitis Connection
RSV can cause laryngitis, a specific manifestation known as viral croup, medically termed laryngotracheobronchitis. While parainfluenza virus is the most common cause, RSV frequently triggers croup. The infection begins in the upper respiratory tract and travels downward, causing inflammation in the larynx and trachea (windpipe).
This viral invasion causes the tissues lining the subglottic space—the narrowest part of a child’s airway below the vocal cords—to swell considerably. Because children have smaller, less rigid airways, even slight swelling significantly restricts the passage of air. This narrowing of the upper airway produces the distinctive symptoms of croup. The characteristic sounds associated with croup are a direct result of air being forced through this swollen and constricted area.
Identifying the Distinctive Symptoms
The inflammation caused by RSV leads to a set of distinctive symptoms. The most recognizable sign of croup is the harsh, resonant, “seal-like” or “barking” cough. This auditory hallmark is produced when air rushes past the swollen vocal cords and trachea. The child will also exhibit hoarseness or a raspy quality to their cry or voice due to the inflammation of the voice box.
Another symptom is stridor, a high-pitched, noisy, and often squeaking sound made when the child breathes in. Stridor may only be noticeable when the child is crying or agitated, but in severe cases, it can occur even when the child is at rest. Croup often begins with general cold-like symptoms, such as a runny nose and mild fever, before the distinctive cough and stridor emerge, usually worsening at night.
Managing RSV-Induced Laryngitis and When to Seek Care
Management of mild RSV-induced laryngitis focuses on keeping the child comfortable and maintaining open airways. A simple strategy is using a cool mist humidifier in the child’s room to soothe irritated airway linings. Some parents also find that exposing the child to cool, night air for a few minutes can help reduce the swelling, though they should be dressed appropriately.
Keep the child as calm as possible, since crying and agitation worsen symptoms by making breathing more difficult. Offering plenty of fluids is important to prevent dehydration and keep respiratory secretions thin. Fever or discomfort can be managed with an age-appropriate dose of acetaminophen or ibuprofen, as directed by a healthcare provider.
Caregivers must be aware of warning signs indicating the condition is worsening and requires immediate medical attention. Seek emergency care if the child develops severe stridor that is present even when they are calm or at rest. Serious signs include difficulty breathing, such as fast breathing or chest retractions, where the skin pulls in around the ribs, neck, or collarbone with each breath. Immediate care is also necessary if the child’s lips or skin take on a pale, grayish, or bluish tint, or if the child is lethargic, unresponsive, or unable to swallow saliva due to the swelling.