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Croup

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is croup?

Croup is a common illness in young children and usually occurs in children less than three years of age. Croup can cause narrowing of the upper airways. Signs and symptoms include a hoarse voice, a barking cough, and noisy breathing. Croup can last for a few days and usually the signs and symptoms are more severe at night. Before the cough develops, your child may have a sore throat, increased temperature, red eyes, a runny nose, or have a poor appetite. With the cough, you might notice that the breastbone is drawn into the chest as your child breathes in and a 'crowing' sound called stridor may also be heard. Your child's voice is usually hoarse and breathing can become difficult especially if he/she becomes upset.

Some children have many episodes of croup - these episodes usually occur at night and do not last long, often settling within an hour or so. This is sometimes called "spasmodic croup" and can come on suddenly often without a preceding cold. This form of croup is more common in children who either have or may develop asthma.

Why does it happen?

When you breathe, air passes through the voicebox (larynx) and windpipe (trachea) into the lungs. In croup, the voice box and windpipe become inflamed and narrowed because of swelling of the lining and increased mucus. This blockage causes the windpipe to partly collapse - like when you suck hard on a blocked straw. Young children who have small soft windpipes have the most difficulty. The size and strength of the windpipe increases as children grow up which is why croup is less common in older children.

What causes the blockage?

Most episodes of croup are due to viral infections although this is often not the case in children with spasmodic croup where there may be no obvious trigger.

Treatment

Mild croup can be managed at home. The symptoms of croup are often worse at night when the air is cooler. Humidification of the air is often recommended but there is no information to prove that it does benefit the symptoms of croup. In fact the risk of hot water or steam burns is potentially more dangerous for your child than the croup itself.

Do not use steam for your child's croup or cold.

Instead:

• Try to calm and comfort your child
• Encourage your child to drink plenty of fluids.
• If your child's croup gets worse and you are worried that it might be serious, take your child to their doctor or the nearest emergency department for help.

Croup is usually caused by a virus, so antibiotics will not help. Steroid medication and nebulised adrenaline have been found to be effective and are now routinely given in hospital to treat moderate or severe cases of croup. These medicines reduce the swelling in your child’s airway and help them to breathe easier.

How long does it last?

Generally, croup is worse during the first few days of the illness and may sometimes last up to a week. The cough usually lasts longer. There will be no permanent damage after an episode of croup.

When to seek help

If your child has any of the following, go to a doctor or hospital straight away:

• breathing is difficult;
• your child becomes pale or blue (cyanosed) which usually happens after a coughing spell;
• your child becomes restless, irritable and/or delirious;
• you notice the breastbone being drawn in severely;
• your child has a high temperature and is dribbling;
• your child is not drinking enough;
• you become concerned for any other reason.
• the "crowing" noise made by your child is heard when they breathe in and out even when your child is resting.

• Croup is often a mild illness but can get worse quickly.
• Croup is often worse at night.
• Steam does not help and may lead to accidental burns.
• If there is severe breathing difficulty, or, if your child is distressed, contact your doctor or local hospital.
• Croup can quickly become serious, so do not hesitate to get medical help.
• There is effective treatment for severe episodes of croup.

The Children's Hospital at Westmead Tel: (02) 9845 3585 Fax: (02) 9845 3562 www.chw.edu.au	Sydney Children's Hospital, Randwick Tel: (02) 9382 1688 Fax: (02) 9382 1451 www.sch.edu.au	Kaleidoscope, Hunter Children's Health Network Tel: (02) 4921 3670 Fax: (02) 4921 3599 www.kaleidoscope.org.au