Understanding Croup: Causes, Symptoms, Remedies, & When To Seek Medical Attention

Croup, medically known as laryngotracheobronchitis, is a respiratory condition that primarily affects young children and babies. It’s characterized by a distinctive barking cough caused by swelling of the throat (trachea) and voice box (larynx) (1). While croup is usually mild and can be managed at home, it’s essential to monitor your child’s condition closely, as severe croup can be a medical emergency. In this article, we’ll explore croup’s causes, symptoms, and home remedies as well as when to seek medical attention.

What Causes Croup?

Croup itself is not a virus or bacteria but rather a temporary condition typically triggered by viral infections; several viruses can lead to this condition, including influenza, parainfluenza, measles, respiratory syncytial virus, and adenovirus (2). Treatment for croup primarily focuses on supporting the immune system and alleviating breathing difficulties.

Common Signs And Symptoms

Croup often manifests with distinctive symptoms and recognizing them early helps you get on top of care quickly (1).

Common signs of croup:

• Barking Cough: The hallmark symptom of croup is a cough that sounds like a bark due to throat and larynx swelling.
• Breathing Difficulties: Children with croup may experience noisy, harsh sounding, high pitched breathing on their inhale, known as stridor. Stridor is more likely to occur when a child is worked up or crying. If stridor occurs when at rest, emergency medical care is warranted. (Trouble breathing is always an emergency!)
• Chest Retractions: Chest retractions are recognizable by the skin over the sternum or between the ribs being sucked in while breathing. This is a sign of severe croup and requires emergency care.
• Hoarse Voice: The child’s voice may become hoarse or raspy.
• Fever: A mild fever may accompany croup, but it’s usually not very high.

When to Seek Medical Attention

Croup can usually be managed at home, but there are instances when medical attention is necessary. If you are able, I recommend sleeping in the same room as your child until they feel better, so you can keep an eye out for troubling symptoms.

Signs that it’s time to see a doctor:

• Symptoms Persist for Over a Week: If your child’s croup symptoms last for more than a week, consult your healthcare provider.
• Frequent Croup Episodes: If your child frequently experiences croup, it’s important to see a doctor for further evaluation.
• Fever for More Than Three Days: If your child has a fever for longer than three days, seek medical attention
• Fever that doesn’t respond to medication: If your child has a persistent fever that won’t break, even with medication, consult your doctor.
• Fever with signs of dehydration: If your child has a fever accompanied by signs of dehydration, seek medical attention.

When To Go To The Emergency Department

Croup can quickly escalate into an emergency situation that warrants a trip to the ER.

Signs that it’s time to head to the emergency department:

• Drooling or Difficulty Swallowing: If your child experiences drooling or has difficulty swallowing due to breathing problems, seek immediate medical help.
• Inability to Cry or Speak: If your child is unable to cry or speak because of breathing difficulties, go to the emergency department.
• Noisy Whistling Sound While Breathing: A noisy, whistling sound during breathing is a concerning sign that requires emergency care.
• Chest Retractions: If your child’s skin is being pulled in around the ribs or at the top of the breastbone, it’s a sign of respiratory distress that requires prompt medical attention. This video shows a few examples of what this looks like.
• Fever in Infants Under 3 Months: If an infant under three months old with croup develops a fever, it’s crucial to seek immediate medical help.
• Severe or Prolonged Coughing Spells: Prolonged or severe coughing spells may indicate the need for immediate medical evaluation.

Home Remedies

In the absence of emergency signs, croup is usually manageable at home.

Remedies that I recommend in my practice:

1. Maintain Good Hydration: Encourage your child to stay hydrated. For breastfed babies, continue nursing frequently. Older kids who don’t feel like drinking due to sore throats may do best with hydrating popsicles. This sore throat tea is also a great option that combines hydration with soothing herbs.
2. Breathe In Cool Air: Cool air can sometimes provide relief from croup symptoms. Consider taking a walk in the evening or, in the summer, taking a few breaths of cool air from the fridge or freezer.
3. Elevate Head & Shoulders When Sleeping: It is helpful that your child with croup sleeps with their head and shoulders elevated. You can achieve this by using extra pillows or slightly elevating one side of the crib or bed.
4. Apply An Essential Oil Chest Rub: Essential oil chest rubs may help ease coughing and open airways. Choose products designed for children of the appropriate age. I do not recommend chest rubs with a petroleum jelly base. I recommend Henry’s Homestead
5. Use Steam Inhalation: While cold air is usually more effective for croup, some children may find relief with steam inhalation. Be extremely cautious when using steam with young children.
6. Manage Fevers: It isn’t always necessary to treat fevers as they are part of the body’s natural immune response. However, if a fever is causing discomfort, interfering with sleep, is very high, or is persistent, then it is a good idea to attempt to bring it down. For more on managing fevers, read this article.
7. Support the immune system: Plenty of rest and nutrient intake is key for optimal immune function. This is especially important when the body is actively fighting something. For more on how to naturally support the immune system, read this article.
8. Manage throat discomfort and support easy breathing: Certain herbs are known to be calming to the respiratory system. For more on natural cough support, read this article.

Summary

Croup (laryngotracheobronchitis) with its characteristic barking cough can be a distressing condition for both children and parents. It is important for parents to be aware of the signs that their child requires emergency care. In the absence of these signs, croup can usually be effectively managed from home with hydration, immune support, and symptom management.

References:

1. Mayo Clinic. (2019). Croup – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/croup/symptoms-causes/syc-20350348
2. ‌Sizar O, Carr B. Croup. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431070/