Croup is a common respiratory condition in children, recognized by its distinctive barking cough, hoarseness, and a high-pitched, noisy breathing sound called stridor. It arises from viral infections that cause swelling in the upper airway, specifically the voice box (larynx) and windpipe (trachea). While these symptoms are characteristic, other conditions can present similarly. Recognizing these differences is important for proper medical care.
Common Respiratory Conditions
Several common respiratory conditions share symptoms with croup. Bronchiolitis, often caused by respiratory syncytial virus (RSV), affects infants and young toddlers, inflaming the small airways in the lungs. While both involve breathing difficulties and cough, bronchiolitis typically presents with wheezing, rather than croup’s inspiratory stridor.
Spasmodic croup, a distinct form, presents with a sudden onset of barking cough and stridor, often at night without preceding cold symptoms. Unlike viral croup, it may link to allergies or reflux and tends to recur, sometimes without fever. Asthma, a chronic inflammatory airway condition, can also mimic croup during flare-ups in young children, causing coughing, wheezing, and shortness of breath. Asthma symptoms are typically triggered by specific factors and involve wheezing, differentiating it from stridor.
Emergency Airway Obstructions
Some croup-mimicking conditions are medical emergencies due to their potential to severely obstruct the airway. Epiglottitis, a bacterial infection causing rapid epiglottis swelling, presents with sudden high fever, severe sore throat, difficulty swallowing, and drooling. Unlike croup, it typically lacks a barking cough, and affected children often prefer to sit upright in a “sniffing” position to ease breathing. Though rare due to the Hib vaccine, this condition can quickly lead to complete airway blockage.
Bacterial tracheitis, another serious bacterial infection, affects the trachea and can follow a viral illness. Children with bacterial tracheitis often appear very ill with a high fever, and their stridor and cough may not respond to typical croup treatments. This condition can lead to significant airway obstruction due to thick, purulent secretions within the windpipe. A foreign object lodged in the airway can also cause sudden and unexplained choking, coughing, or stridor, particularly in toddlers. The symptoms depend on the object’s location and size, but a sudden onset of respiratory distress without prior illness should raise suspicion for foreign body aspiration.
Other Contributing Factors
Beyond infections, other factors can cause croup-like symptoms. Severe allergic reactions (anaphylaxis) can lead to rapid airway swelling, resulting in stridor, hoarseness, and breathing difficulties. These reactions often involve other signs like hives, itching, or facial swelling, which help distinguish them.
Laryngomalacia is a congenital condition where the larynx is softer than typical, causing it to partially collapse during inhalation and produce stridor. This noisy breathing is often present from birth or early infancy, worsens when lying down or feeding, and is a chronic issue rather than an acute, sudden onset like croup.
Gastroesophageal reflux disease (GERD) can also contribute to croup-like symptoms, especially in infants. Severe reflux can cause chronic cough, hoarseness, and sometimes stridor due to stomach acid irritating or being aspirated into the airway.
When to Seek Help
Recognizing severe symptoms ensures a child receives timely medical attention. Seek immediate medical evaluation if a child experiences significant difficulty breathing, such as rapid breathing, nasal flaring, or retractions (visible pulling in of skin between ribs or at the neck).
Bluish discoloration around the mouth or fingernails indicates dangerously low oxygen levels and requires urgent care.
Drooling or an inability to swallow, combined with breathing difficulties, can signal a severe airway obstruction. A high fever, especially if unresponsive to medication or accompanied by a very ill appearance, warrants prompt medical assessment.
Stridor that is severe, worsens, or occurs at rest are concerning signs. Lethargy, extreme irritability, or any sudden, unexplained severe respiratory distress also requires immediate medical attention.