Croup

Croup

Croup is a childhood condition that affects the windpipe (trachea) and the two airways that branch off from it to the lungs (the bronchi).

A child with croup has a distinctive barking cough and they will make a harsh sound, known as stridor, when they breathe in. A blocked airway can also cause a hoarse voice and breathing difficulties. See Croup - symptoms for more information.

Types of croup

There are two types of croup:

•viral croup (laryngotracheitis), which develops over several days and is caused by an infection

•spasmodic croup, which involves repeated, short-lasting episodes of croup where no infection is present

The same treatments are recommended for both viral croup and spasmodic croup.

How common is croup?

Croup is a fairly uncommon condition that tends to affect more boys than girls. For example, during 2008 and 2009 just over 8,800 children were admitted to hospital in England with croup and epiglottitis (inflammation of the epiglottis, which is a flap of tissue at the back of the throat). Most of these cases were emergency admissions.

Croup usually affects young children aged between six months and three years, with most cases occurring in two-year-olds. However, croup can sometimes develop in older children up to 15 years of age.

It is occasionally possible for a child to experience croup more than once during childhood, with one study finding that it recurs in around 5% of cases.

Outlook

Most cases of croup are mild and get better on their own, without the need for treatment.

Around 60% of croup cases clear up within 48 hours. However, in some cases, the symptoms of croup can last for up to a week.

Urgent hospital admission is needed in more severe cases of croup where the airway is blocked and the child has life-threatening breathing difficulties.

It is very rare for a child to die from croup. In 2008, there were seven deaths in England and Wales as a result of croup.

A child can get croup at any time of the year, although the condition is more likely to occur during the late autumn and early winter months. This may be because there are more colds and viruses around at this time of year.

The initial symptoms of viral croup are similar to those of a cold. They include:

•sore throat

•runny nose

•high temperature of 38°C (100.4°F) or above (in some, but not all, cases)

•cough

Over one to two days, the more specific symptoms that are characteristic of croup will develop. These symptoms are:

•a bark-like cough

•a hoarse or croaky voice

•difficulty breathing

•rasping (a harsh grating sound) when breathing in, called stridor

The symptoms of spasmodic croup are similar to those mentioned above. However, a bark-like cough and stridor tend to occur suddenly (usually at night), with the child feeling well before the specific croup symptoms begin.

Stridor is often most noticeable when the child cries or coughs. However, in more severe cases of croup it can also occur when the child is resting or sleeping. For reasons that are unclear, the symptoms of croup tend to be worse at night.

Although the symptoms of croup usually only last for a few days, they can occasionally last for up to a week.

When to seek medical advice

Croup is a condition that can usually be diagnosed by a GP and mild cases can usually be effectively treated at home.

However, if your child’s symptoms are severe (see below), you should take them to the nearest hospital’s accident and emergency (A&E) department or dial 999 for an ambulance.

You should seek immediate medical attention if your child has any of the following symptoms:

•severe breathing difficulties

•increased breathing rate (they are too breathless to feed or talk) or 'silent chest' (you are unable to hear sounds of breathing)

•worsening cough or rasping sound (stridor)

•distress and agitation

•the skin appearing dark, blue-tinged or pale

•the skin around the ribs and chest appearing to be pulled in and tight, making the bones of the chest and ribs more visible

•abnormal drowsiness and sleepiness

•a high temperature of 38°C (100.4°F) or above

•a rapid heartbeat or a falling heart rate

Some of these symptoms may indicate a potentially life-threatening underlying condition called epiglottitis (inflammation of the epiglottis, which is the flap of cartilage that closes off the entry to the voice box when you swallow). The symptoms could also indicate tracheitis (inflammation of the windpipe), which also requires immediate medical attention.