Skip to main content

URMC Logo

URMC / Encyclopedia / Content

Croup

What is croup?

Croup is a disease that causes swelling in the upper portion of the airway in the neck and problems breathing. Children with croup often have a high-pitched “creaking” or whistling sound when breathing in. This is called stridor.

What causes croup?

Croup is most commonly caused by a virus. It is sometimes, but rarely, caused by bacteria, allergies, or reflux from the stomach. Viruses that are known to cause croup are:

  • Parainfluenza virus

  • Respiratory syncytial virus (RSV)

  • Influenza virus

  • Adenovirus

  • Enteroviruses

Croup is spread through direct contact with a person, or fluids from another person who has the disease. The infection starts in the nose and throat and moves into the lungs. Swelling affects the area around the voice box (larynx) and into the windpipe (trachea).

Younger children are more affected by croup because their airways are smaller. Therefore, a small amount of swelling can make it really hard for an infant or small child to breathe.

  • Croup is most commonly seen in children 3 months old to 5 years.

  • The peak time for croup to occur is 2 years old.

  • Croup is seen more often in the winter.

What are the symptoms of croup

Symptoms of croup are not always the same. As the disease moves from the nose to the lungs, the symptoms can change. Common symptoms of croup are:

  • A runny nose, a stuffy nose, and slight cough

  • A cough that turns into a "seal's bark"

  • Laryngitis (losing his or her voice)

  • Fever

  • Stridor

Symptoms are often worse at night and wake the child from sleep. Symptoms also seem to improve in the morning but worsen as the day goes on. Most children improve in three to seven days. The symptoms of croup can be mistaken for other conditions and medical problems. Always see your child's provider for a diagnosis.

How is croup diagnosed?

A small sensor is placed onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot. Click Image to Enlarge

Your child’s provider will do a complete medical history and physical exam. He or she can usually diagnose croup based on the physical exam. If there is concern that your child may have other illnesses, your healthcare provider may order neck or chest X-rays, or blood tests.  In some cases, your child's provider may do pulse oximetry. An oximeter is a small device that clips onto the end of the finger that  measures the amount of oxygen in the blood.

Treatment for croup

In severe cases of croup, or if your child is not breathing well, your child may need to go to the hospital.  You can manage most milder cases at home. But, it can sometimes hard to tell if your child needs to go to the hospital because the disease changes. Your child may seem better at one moment, and then get worse the next. Your child's provider may also order the following medicines to help with the symptoms of croup:

  • Inhaled medicines. These are used if your child is having significant trouble breathing. Inhaled treatments may be used to decrease the stridor and increased work of breathing.

  • Steroids (injected or oral). An injectable steroid is often given if the child can't tolerate oral steroids. This can help prevent the illness from getting worse. 

If your doctor feels your child's croup is due to allergies or reflux, he or she may prescribe other medicines. Antibiotics are not useful in the treatment of viral croup.

Home care for croup

Croup can be frightening. But, in many mild cases, these methods can help ease your child's breathing:

  • Make sure there is no smoking in the home. Smoke can make your child's cough worse.

  • Keep your child's head elevated. Prop an older child up in bed with extra pillows. Put infants in a car seat. Never use pillows with infants younger than 12 months of age.

  • Sleep in the same room as your child to help your child right away if he or she starts to have trouble breathing.

  • Stay calm. If your child sees that you are frightened, it will increase his or her anxiety and trouble breathing.

  • Offer words of comfort.

  • Sing your child's favorite bedtime song.

  • Offer a back rub or hold your child.

  • Offer a favorite toy.

The American Academy of Pediatrics and the American Academy of Family Physicians state that no studies prove that inhaling steam in a bathroom or inhaling cool night air helps improve a child's breathing. Other medical sources still support their use. If the previous methods do not help your child's breathing, and your child breathes easier after inhaling steam or cool, moist night air, use the following approach.

  • Turn on the hot water in your bathroom shower.

  • Keep the door closed so the room gets steamy.

  • Sit with your child in the steam for 15 to 20 minutes. Do not leave your child alone.

  • If your child wakes up at night, try bundling him or her and go outside to breathe in the cool night air.

Medical Reviewers:

  • Adler, Liora, C., MD
  • Fraser, Marianne, MSN, RN