Croup

  • Medical Author:
    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quick GuideChildhood Illnesses: A Parenting Guide to Sick Kids

Childhood Illnesses: A Parenting Guide to Sick Kids

What are croup symptoms?

Viral croup can have two distinct presentations, both of which are a consequence of swelling of the vocal cords resulting in a narrowing of the airway. The more common variety has symptoms of fever (100 F-103 F), mild hoarseness, and sore throat two to three days after virus exposure. Quick to follow is the characteristic dry "barking seal" cough that may be associated with a harsh, raspy sound during inspiration. (This sound, called "stridor," has been noted to resemble the breathing of the Star Wars character Darth Vader.) The symptoms commonly last for four to seven days.

The alternative and less frequent presentation is called "acute spasmodic croup." These children will appear totally well when put to bed at night only to awaken their parents in the middle of the night with the above described barky cough and stridor. Fever and sore throat are not noted in these children, and the symptoms commonly resolve within eight to 10 hours from onset, and the child appears totally well until this same acute onset recurs the following night. This on/off pattern may occur over three to four nights in a row and then morph in to symptoms more characteristic of the common cold -- mucus-like nasal discharge and a "wet" cough for several days.

These two different presentations are the result of the particular virus that has infected the child. Manifestations of croup vary from mild (common) to life-threatening (rare). The severity of symptoms is proportional to the amount of relative narrowing of the airway. The more severe the vocal cord narrowing the more effort is required to inhale. A severely sick child will refuse to lie down, demanding to remain in an upright position. They will show retractions of the skin above the collarbone and between the ribs with inspiration and may develop facial cyanosis (bluish skin discoloration). Apparent exhaustion and decreased respiratory effort are an indication of impending respiratory failure and are cause for immediate paramedic evaluation and transport to the emergency department of the closest hospital.

In general, the duration of symptoms of croup is five to seven days. More severe croup may resolve in 14 days. Continue Reading

Reviewed on 12/14/2015
References
REFERENCES:

Malhotra, A., and L.R. Krilor. "Viral Croup." Pediatrics in Review 22.1 Jan. 2001: 5-12.

United States. Centers for Disease Control and Prevention. "Human Parainfluenza Viruses (HPIVs)." Aug. 18, 2015. <http://www.cdc.gov/parainfluenza/index.html>.

Woods, Charles R. "Patient Information: Croup in Infants and Children." UptoDate.com. Aug. 18, 2010. <http://www.uptodate.com/patients/content/topic.do?topicKey=~IJIXh1W5371lMy>. IMAGES:

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