What Is Croup and Its Link to COVID-19 in Children?

Reports have indicated that children could have different COVID-19 symptoms than adults. Specifically, children who developed COVID-19 could also show signs of laryngotracheobronchitis, or croup.

Croup is a respiratory infection that often happens in young children but can happen to anyone. Viruses or bacteria cause croup, which is treatable and preventable.

The main symptom is a "barking" cough, often with a hoarse voice. The cough can be alarming—especially if it appears in a child with COVID-19. Here's what you need to know about croup cough and COVID-19.

Croup Symptoms and Causes

The most notable symptom of croup is a bark-like cough. Some people describe the cough as sounding like a seal barking. Croup also makes the voice hoarse.

Other symptoms can also show up with croup, including:

• Fever
• Rash
• Eye redness
• Swollen lymph nodes

Overall, symptoms of croup may last for a few days and are worse at nighttime.  

Croup can be alarming to hear, but it's not always dangerous. Still, croup can cause difficulty breathing if paired with another less-common symptom—stridor, or breathing that sounds like gasping.

Respiratory viruses, such as parainfluenza RSV, measles, adenovirus, and influenza, cause croup. In severe cases of croup, bacteria may be the cause.

How Is Croup Diagnosed?

A healthcare provider will ask about your child's medical history and do a physical exam. During the exam, the healthcare provider will listen for wheezing and watch for any breathing or breath sound issues.

Comorbid Conditions

Croup has comorbidities with other illnesses. One study published in 2015 found that some of the most common comorbidities include:

• Upper respiratory infections
• Pneumonia
• Bronchitis
• Bronchiolitis
• Asthma
  

What’s the Link Between Croup and COVID?

As the Omicron variant of COVID-19, specifically, surged throughout the United States, pediatric cases of the virus were on the rise. The reason why croup has been seen in children with COVID-19 may have a lot to do with two things: the body part that COVID-19 primarily affects and children's anatomy.

The Omicron and Delta variants more often cause mild upper respiratory issues than previous variants. Those issues include sore throats, runny noses, sneezing, and coughing.

Also, croup causes swelling of the voice box and the windpipe, or trachea. The swelling can cause children's airways to constrict more since their airways are smaller than in adults.

Treatments for Croup

Getting your child tested and isolated from other healthy family members is essential if they show any symptoms of croup and COVID-19.

Prescription medicines for croup might include glucocorticoids for mild cases or dexamethasone or epinephrine for moderate to severe cases. No specific over-the-counter (OTC) medicine is available to treat croup. Instead, remedies focus on household solutions. 

At-home remedies for croup include:

• Use mist, either from a humidifier or from the steam of running hot water in the bathroom.
• Allow the child to breathe cool air outside at night or use a cool air vaporizer.
• Treat the cough with warm, clear fluids or frozen juice popsicles.
• Keep the child's head elevated.

When To See a Healthcare Provider

Consult a healthcare provider if:

• Your child has a fever that lasts more than three days
• Croup symptoms last longer than a week
• You have concerns about your child's condition

While croup does not usually turn severe, monitoring your child's breathing is essential. It's time to seek help from a healthcare provider if, at any point, your child begins noticeably working harder to breathe. They may look like they are using the muscles between their ribs to inhale, which is known as retraction.

Immediate medical attention is necessary if croup worsens. Hospitalization is the next step if croup symptoms get worse after treatment.

Usually, children require hospitalization in cases of oxygen therapy, severe dehydration, and the need for multiple epinephrine doses. Less than 5% of children with croup require hospitalization.

Other than your child having difficulty breathing, symptoms that require quick medical care include:

• Pale or blue skin
• Severe bouts of coughing
• Drooling or problems swallowing
• Problems talking or crying because of breathing issues

Call emergency medical services if your child experiences skin changes, agitation, breathing struggles, and extreme drowsiness.

How To Prevent Croup and COVID-19

Prevention is critical for the best health outcomes. Precautions such as proper handwashing lower the risk of spreading croup and COVID-19. Keeping children up-to-date on vaccines can protect against COVID-19. COVID-19 vaccines and booster shots are available for children 6 months and older.

Children aged 5 and older who have completed the Moderna or Pfizer-BioNTech primary series are eligible for a booster shot.

A Quick Review

Some children who develop COVID-19 can have croup symptoms. For the most part, croup is treatable at home. Consult a healthcare provider if symptoms worsen or last longer than one week. Precautions like proper handwashing and vaccines can help prevent croup and COVID-19.