Croup is a common viral respiratory infection primarily affecting infants and young children. Swelling in the voice box and windpipe narrows the airway just below the vocal cords, causing the characteristic symptoms associated with the illness. While most cases are mild and manageable at home, understanding the severity of symptoms is important for parents and caregivers. They must know when symptoms require immediate medical attention and a trip to the hospital.
Recognizing Typical Croup Symptoms
The most identifiable sign of croup is a harsh, “barking” cough that often sounds like a seal. This distinctive noise occurs when air is forced through the swollen and narrowed upper airway. The infection usually begins with general cold-like symptoms, such as a runny nose and low-grade fever, before the cough develops over 12 to 48 hours.
Symptoms typically worsen in the evening hours, often waking a child from sleep. Inflammation of the vocal cords may also cause hoarseness or a change in voice. In mild cases, a high-pitched, rasping sound called stridor is only noticeable when the child is crying or physically upset.
Effective Home Management for Mild Croup
For mild croup where breathing is not severely labored, supportive home care can ease symptoms and provide comfort. Keeping the child calm is important, as distress and crying can worsen airway swelling and intensify symptoms. Encourage the child to drink plenty of fluids, such as water or frozen popsicles, to maintain hydration and soothe a sore throat.
Exposure to cool, moist air can help shrink swollen tissues and improve breathing. Parents can try taking the child outside briefly into the cool night air. Alternatively, sitting with them in a bathroom filled with steam from a hot shower may help, but ensure the child is kept away from hot water. Over-the-counter pain relievers like acetaminophen or ibuprofen may be given to manage discomfort and fever, following appropriate dosing instructions for the child’s age and weight.
Urgent Warning Signs Requiring Hospital Care
A child needs immediate medical attention if symptoms suggest significant airway obstruction or respiratory distress. The most serious indicator is stridor—the high-pitched, noisy breathing sound—occurring when the child is quiet and at rest. This signifies severe airway narrowing even without the stress of crying or movement.
Look for signs of labored breathing, known as retractions. This is when the skin pulls in sharply between the ribs, above the collarbone, or below the breastbone with each inhaled breath. These visible movements show the child is using extra muscles to pull air into their lungs. Another sign is cyanosis, a bluish or dusky color around the lips, nose, or fingernails, indicating low blood oxygen levels.
Emergency care is required if a child appears excessively tired, unusually quiet, or difficult to wake up, suggesting insufficient oxygen. If the child is drooling excessively or has difficulty swallowing, this may indicate a different, more serious condition or severe obstruction. Seek immediate help if the child fails to improve after 15 to 20 minutes of exposure to cool or moist air. Severe dehydration, indicated by a lack of urination or dry lips, also warrants professional medical evaluation, especially if the child is too breathless to drink.
Medical Interventions in the Emergency Room
Upon arrival at the emergency room, the medical team focuses on stabilizing the child’s breathing and reducing airway swelling. Standard treatment involves administering a corticosteroid, usually dexamethasone, which effectively decreases inflammation. This medication is often given as a single oral dose and has a long duration of action, helping to reduce the chance of symptoms returning.
For children in acute respiratory distress, a nebulized treatment with epinephrine (adrenaline) may be administered. Epinephrine is inhaled as a fine mist and acts quickly to temporarily shrink swollen airway tissues, providing rapid relief of breathing difficulties. Because its effects are short-lived, children receiving nebulized epinephrine are observed for several hours in the emergency department. This ensures symptoms do not worsen once the medication wears off. If blood oxygen saturation levels are low, supplemental oxygen may also be provided through a mask or nasal cannula.