Concerns have grown regarding the potential link between COVID-19 and croup, particularly among parents of young children. This article aims to clarify the relationship between these two respiratory conditions, offering insights into their symptoms, how COVID-19 can manifest as croup, and guidance on identifying and responding to such symptoms.
Understanding Croup
Croup is a common respiratory infection that primarily affects infants and young children, typically those between 3 months and 5 years of age. This condition involves the swelling and narrowing of the upper airways, specifically the voice box (larynx) and windpipe (trachea). The characteristic symptoms arise from this swelling, making breathing difficult and noisy.
Most cases of croup are caused by viral infections, with parainfluenza viruses being the most frequent culprits. Other viruses, such as respiratory syncytial virus (RSV), influenza, adenovirus, and enteroviruses, can also lead to croup. Symptoms often begin like a common cold, including a runny nose, stuffy nose, and fever.
As the upper airways become irritated and swollen, a child may develop a distinctive “barking” cough, often compared to the sound of a seal. They might also experience hoarseness and a high-pitched, squeaky noise when breathing in, known as stridor. These symptoms are often more pronounced at night and when the child is upset or crying.
COVID-19 and Respiratory Illness in Children
COVID-19, caused by the SARS-CoV-2 virus, can affect children of all ages, though symptoms are frequently milder than in adults. The incubation period, or the time from exposure to symptom onset, is generally between 2 and 14 days. Common respiratory symptoms of COVID-19 in children include fever, cough, and congestion or runny nose.
Children might also experience other symptoms such as sore throat, fatigue, headache, muscle aches, or gastrointestinal issues like nausea, vomiting, and diarrhea. While many children have mild or asymptomatic infections, some can develop more severe illness. Rarely, COVID-19 can lead to multisystem inflammatory syndrome in children (MIS-C), a serious condition involving inflammation across multiple body systems.
The Connection: COVID-19 as a Cause of Croup
The SARS-CoV-2 virus, particularly the Omicron variant, has been observed to cause croup in young children. Researchers suggest that the Omicron variant may preferentially target the upper respiratory tract, which includes the voice box and windpipe, similar to how other common croup viruses behave.
When the SARS-CoV-2 virus infects the upper airways, it can lead to inflammation and swelling, resulting in the characteristic barking cough and stridor associated with croup. Studies have indicated that COVID-19-associated croup cases, especially during the Omicron wave, can sometimes be more severe, requiring more medical intervention and hospitalization than croup caused by other viruses. For instance, one study found that 12% of children with COVID-19 and croup needed hospital care, with a portion requiring intensive care.
Identifying and Responding to Symptoms
Recognizing the specific signs of croup, especially when COVID-19 is suspected, involves observing a combination of symptoms. Other symptoms like a runny nose, sore throat, and fever are common to both croup and COVID-19.
If a child exhibits symptoms of croup, particularly the distinctive cough or noisy breathing, it is prudent to consider COVID-19 as a possible cause, especially if there has been a known exposure or if local COVID-19 rates are high. A healthcare provider can determine the cause through examination and potentially testing. Most mild cases of croup can be managed at home by keeping the child calm, ensuring they drink plenty of fluids to prevent dehydration, and using a cool-mist humidifier. Some parents find that cool outdoor air can also help alleviate symptoms.
However, certain signs indicate the need for immediate medical attention. Seek emergency care if a child experiences severe breathing difficulties, such as struggling to breathe, skin pulling in around the ribs with each breath (retractions), or a high-pitched sound when breathing even at rest. Other serious indicators include bluish lips or skin, increased fatigue or sleepiness, difficulty swallowing or drooling, or if the child is unusually quiet or unresponsive. Contact a healthcare provider if symptoms do not improve after a few days, if the fever persists for more than three days, or if you have any concerns about your child’s condition.