Croup is a common viral, sometimes bacterial, infection which occurs in a child’s upper airways.

Children between six months and four years experience this illness.

The condition is rarely seen in older children.

a. Signs/Symptoms of Croup. A child who has croup has usually just had a cold or other infection. Signs and symptoms of croup include the following:

(1) Airway obstruction caused by edema (swelling of tissues).

(2) Hoarse voice with high-pitched sounds.

(3) A whooping sound when the child breathes in.

(4) Avoidance of lying down. The child breathes easier in an upright position than when he is lying down. Therefore, he resists efforts of adults to make him lie down.

(5) As edema in the airway increases, the child’s use of his accessory muscles of respiration causes the following:

(a) Nasal flaring.

(b) Tracheal tugging.

(c) Retractions of intercostal and suprasternal muscles.

(6) Signs of hypoxia (abnormal reduction of oxygen in body tissues; also called oxygen deficiency) such as:

(a) Restlessness.

(b) Increased pulse rate.

(c) Eventually, cyanosis.

NOTE: A croup attack usually occurs at night. A child with croup will seem to be fairly healthy during the day, with some hoarseness. He goes to bed and begins to have a harsh, metallic cough. This cough progresses to a loud, barking, alarming noise around midnight.

b. Treatment for Croup. Follow these procedures:

(1) Administer humidified oxygen by mask.

(2) Initiate an IV of dextrose in water at the rate of 5 ml per kilogram of the child’s weight.

(3) Place the child in the most comfortable position for his breathing.

(4) Transport the child to a medical treatment facility.

NOTE: Similar signs and symptoms may imply upper airway obstruction by a foreign object. If this is the case, cautiously visualize the airway with a light. Use extreme gentleness to avoid causing a laryngospasm (spasm of the larynx).

NOTE: The initial treatment given at home to a child with croup is for the parents to run a hot shower to humidify the air in the bathroom. A parent then sits close to the shower with the child.