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Facts and advice about croup and a barking cough. Written by pediatricians for parents. ‘False’ croup, viral croup or croup as we know it today, manifests itself as a barking cough, often at night, in young children. Sometimes children have trouble breathing. Interestingly, the ‘real’ croup caused by diphtheria, has been eliminated in Sweden thanks to our excellent vaccination program. When we talk about the disease today, we refer to ‘false’ croup, which is a viral disease.
A barking cough might be croup
In the video you can listen to a child with whooping cough. The girl’s coughs make special barking sounds, typical of croup. You can also see how there is a strain to her breathing (pay attention to her chest).
Mild croup is noticeable only by the barking cough. Severe croup is when the child also has difficulty breathing, or their inhalation becomes noisy and sounds ‘harsh’.
What causes ‘false’ croup?
The cough and other associated signs and symptoms of croup are due to swelling of the upper respiratory tract (around the vocal cords) and in conjunction with colds. It is also called laryngitis, or acute obstructive laryngitis. In some children, the disease tends to recur with colds.
When do I need to seek medical care for croup?
Mild croup where the child is experiencing a light barking cough without the labored breathing, is not dangerous. However, it usually affects both children and parents’ sleep. Learn how to assess whether your child has difficulty breathing in the post about labored breathing in children.
Severe croup, where the child has difficulty breathing, and every inhalation is noisy, can become dangerous. In rare cases, often in young children, and children with particularly narrow or malformed respiratory tract, the condition can become life-threatening if it is not treated in hospital.
What should I do when my child gets a croup?
Calm the child!
When your child has a coughing attack, you should:
1. Calm the child!
2. Calm the child!
3. Calm the child!
This is so important! When a child with croup gets upset, the coughing begins, and my impression is that it exacerbates the swelling of the airways itself. So take your child up into your arms, comfort and sing their favorite lullaby. If your child stops coughing and falls asleep, let them sleep slightly upright on your lap or against your chest. If they sleep peacefully for an hour, you can place them in their bed.
Does cold air help relieve croup?
Cold air is often recommended to relieve ‘false’ croup. There are no scientific studies done on whether cold air helps. There are a couple of small studies done to see if inhaling steam helps, but they have shown no benefit.
Feel free to try it! If you can’t calm your child, try to sit down with them wrapped in a blanket by an open window. If it helps, great! Then they can sleep under extra thick duvets with open windows.
When do I go to the hospital?
If your child has frequent repeated coughing attacks associated to croup, and sleep becomes impossible; go to the pediatric emergency room or emergency room. There is effective treatment!
If your child has a barking cough and difficulty breathing; go to the pediatric emergency room!
If your child has a barking cough and is struggling to breath to the point where they panic, or if they have to devote so much energy to breathing that they lie slack; call the emergency services and request an ambulance!
Treatment for croup
There are two effective medications for croup:
1. Inhaled adrenaline. This works within 30 minutes, but the effect does not last longer than two hours.
2. Corticosteroid tablets (dissolved in water before giving them to the child). This is effective within 6 hours and works for 12 hours, but not 24 hours after the dose is given.
Medicines for croup on prescription
Unfortunately, doctors can’t prescribe inhaled adrenaline for home use. It is only available via inhalation machines aka nebulizer (brands include Ailos or Albatross). If your child has really severe asthma, then a doctor can prescribe adrenaline via nebulizer.
Corticosteroid tablets can be prescribed, but should not be given to children who have only had the occasional, or mild croup attacks. These are potent drugs that should not be taken unnecessarily or overdosed. However, if your child has repeated attacks, check with a doctor if you can get corticosteroid tablets to have at home. In case of an attack, corticosteroid treatment decreases the length of episodes.
Read more about giving cortisone to children
Cough medicines, such as Mollipect, Cocillana and Lepheton, do not help against croup.
Croup or intrinsic asthma?
Croup is a swelling in the vocal cords, which gives a barking cough and bee-like sounds upon inhalation. Some children tend to get croup with many colds. Intrinsic asthma is an inflammation of small bronchial tubes in the lungs. The wheezing is evident upon exhalation, where the child squeezes out air and it becomes prolonged. The cough often sounds squeaky.