What is croup ?

Croup is caused by a swelling in the larynx (voice box). Viral infections such as parainfluenza, RS and influenza viruses are the main causes.
Symptoms include hoarseness due to swelling around the vocal cords and a harsh barking cough that sounds similar to a dog or seal.
As the disease advances breathing may become difficult and a high-pitched sound may be heard as your child breathes in. Signs for the advanced croup are retractions just above the breast bone, between the ribs and in the pit of the stomach with each breath.
Your child may be irritable, suffer loss of appetite and have difficulty sleeping because of the breathing difficulties.
In general, the part of a trachea just under the larynx is as narrow as a child’s little finger, so even the slightest swelling there can make breathing difficult.


A medication called Bosmine(Epinephrine), which must be inhaled, is extremely effective. It takes effect quickly and when inhaled reduces the swelling around the vocal cords, which in turn will ease breathing quickly. Since it is also eliminated from the body quickly, it can be re-administered after one hour.
Steroid treatment may be used to reduce the swelling in more severe cases. Antibiotics may also be prescribed to eliminate any suspected bacterial infection.
Hospitalization may be required when the above mentioned treatments fail to relieve the symptoms

Caring for your child at home

1 Adding moisture to the air
    Boiling water, using a humidifier or hanging wet towels in the room may help add moisture to the air.
2 Diet
    No restrictions on foods. However, spicy food may induce coughing. Increased fluid intake is   
3 Medication to reduce the fever
    If your child gets irritable due to a high fever, using medication to reduce the fever is recommended.
4 Preventing crying
    Crying worsens the swelling in and around the vocal cords. Try to pacify your child so s/he doesn’t cry. Sleep in the same room as your child so that you can hear if s/he has any breathing difficulties.

When to seek further medical advice:

Consult a doctor at once when breathing difficulties become more severe. The signs of severe breathing difficulties are as follows.
・Short and rapid breathing, making short breathing noise
・Retraction just above the breast bone
・Retraction between the ribs
・Retraction in the pit of the stomach
When your child looks distressed and is irritable

Keiko Fukuyama M.D.