Croup by Prof. Victor Grech

Croup is not only a condition but is actually a description of the characteristic sound that young children sometimes make when they develop laryngitis.

Laryngitis is usually caused by a viral infection of the throat and the vocal cords (latin: larynx). This may cause fever, throat pain and hoarseness as the vocal cords do not function well. Moreover, in children under 5 years of age, breathing inward (inspiration) may cause a noise that sounds like the word ‘croup’ (technically known as inspiratory stridor), hence the name. This is caused by the fact that the voice box is the narrowest part of the airway, hence any inflammation and swelling, at this part, may significantly obstruct breathing.

Viral laryngitis is a respiratory infections illness, so like a cold, it is caught by being in very close contact with someone who has the infection.

Croup often begins like a cold, including cough and runny nose, but then develops into a particular barky type of cough. Breathing may become rapid, difficult and noisy and any activity that increases the rate of breathing (even crying or excitement) could make croup sound worse. Croup is also most severe at night. In the most severe cases, a child’s breathing can become difficult and hospitalization may be necessary. Antibiotics do not work because the infection is caused by a virus.

The child should be kept comfortable, offered fluids, and given standard medications for fever and pain (paracetamol etc). Associated symptoms such as a runny nose may also be treated. Fresh air and a well ventilated room are also helpful.

A doctor should be consulted if symptoms continue or worsen. A steroid, in such a setting, may help by relieving the inflammation in the throat. 

A doctor should be consulted immediately if the child:

• Of any age has a fever for more than 72 hours
• Is under 6 months old and has a fever.
• Has rapid or difficult breathing.
• Has a severely sore throat.
• Has new or increased amounts of drooling of saliva.
• Is refusing to swallow.
• Experiences discomfort when lying down. 
• These are all worrying signs, particularly those of respiratory obstruction and should be seen to urgently.