We love to welcome the crisp fall air, but unfortunately a lot of seasonal viruses feel welcomed this time of year too! Croup is an obnoxious companion of many of these viruses that love to start popping up as the leaves change colors and the holidays roll in.

Most identifiable by a loud, seal-like barking cough, croup is an upper airway infection that obstructs breathing. The illness is relatively common among young children (6 months to 5 years of age) due to their airway anatomy. As stated above, croup is caused by a viral infection and is most frequently linked with parainfluenza virus type 1. However, other viruses can cause croup as well.

What to Look For

• A loud “barking” cough
• Inspiratory Stridor (a high pitched sound when breathing in) that usually only occurs when your child is upset
• Typical viral features (think runny nose, congestion, and/or fever)

What to Do

If you believe your child has croup, try and help them get as hydrated, relaxed, and comfortable as quickly as possible. I know it almost sounds trivial, but the croupy cough typically sounds worse when your child is upset. And in most cases, the stridor is only present when your child is really worked up. There are not necessarily studies to support it, but many have also found that a lot of the croup symptoms subside with cold air. Taking your child outside is preferable, but if that isn’t possible, have them stand in front of the freezer for a few minutes (then they might decide to have a Popsicle too, win-win!). Maybe they’re just happier outside—or with a Popsicle in hand—and that is why they sound better. Either way, try these tactics if your child has turned into a seal cub in the middle of the night. Also, if they seem uncomfortable and/or have a fever, you can give them their recommended dose of pain reliever medicine based on their weight and age.

Now, if your child is experiencing stridor (a loud, high-pitched, whistling sound mentioned above) while they breathe,  we would certainly recommend an evaluation. If the cause of your child’s stridor is croup, they may need steroids. Here at Parkside, we try to be diligent with steroid use in children—not ideal for growing bones!—but stridor with croup is usually an indication that we may need to consider steroids as a treatment. It’s worth noting that not all stridor is croup. Stridor can have other non-infectious and infectious causes such as epiglottitis which is an emergency. Thankfully, epiglottitis is very rare and vaccine preventable! Even so, stridor always deserves an evaluation. 

If there is ever a concern that your child is in serious respiratory distress (i.e. appears to be breathing so hard that they are fatigued from breathing, or there appears to be skin sucking in between ribs or at the top of the breast bone with every breath, or has blue lips or gums etc.) call us or take them to the ER depending on your level of concern. There is another medicine, racemic epinephrine, which is sometimes used in the ER for severe croup and can be quite effective. If you live in the upstate, we recommend using the Children’s ER on Grove Road in Greenville whenever possible.

What Not to Do

A common misconception around croup is that antibiotics are a treatment option. In reality, antibiotics will not help in relieving croup symptoms as croup is caused by a virus. Cough syrups also should not be used to treat croup and may even cause harm. Honey however may be used to help calm the cough in children over the age of 1. Warm juice may be used for even younger children.

I hope this post has helped you learn a bit more about croup and gives you some peace of mind if you think your child has this common illness. That said, breathing issues are scary. I don’t have a study to confirm this, but I think breathing concerns are probably the most common reason that pediatricians bring their own children in to be evaluated. So, if you ever think something is off with your child’s breathing, please don’t feel silly bringing them in! Croup or not, it’s never a wrong decision to prioritize your child’s health.

Until next time,

Dr. Lindsey Gouge

Parkside Provider, kayaker, and ice cream’s biggest fan