How Do You Treat Croup at Home?

Croup is a viral respiratory infection common in children up to three years old. Rest, fluids and humidifiers are often the best treatment for croup.

Croup (also called laryngotracheobronchitis) is a viral respiratory illness characterized by high-pitched, noisy breathing (stridor), barking cough, and hoarseness.

Croup commonly affects children six months to three years of age.

Early symptoms of croup include: 

• Runny nose
• Congestion
• Inflammation of the mucus membranes inside the nose (coryza)

After the initial symptoms, croup progresses over 12 to 48 hours and symptoms include:

• Fever
• Hoarseness
• Barking cough
• High-pitched, noisy breathing (stridor)
• Mild sore throat
• Mild fast, shallow breathing 
• Pneumonia (in severe cases)

The cough associated with croup typically goes away within three days. Other symptoms may persist for up to a week and then gradually resolve.

Croup is usually caused by viruses. Secondary bacterial infection may occur.

Viruses that cause croup include: 

• Parainfluenza viruses
• Respiratory syncytial viruses (RSV)
• Adenoviruses 
• Human coronavirus NL63 (HCoV-NL63)
• Measles (in areas where measles remains prevalent)
• Influenza viruses (uncommon)
• Rhinoviruses
• Enteroviruses (especially Coxsackie types A9, B4, and B5, and echovirus types 4, 11, and 21)
• Herpes simplex viruses 
• Metapneumoviruses 

Croup also may be caused by bacteria, including Mycoplasma pneumoniae.

Secondary bacterial infections of croup include: 

• Staphylococcus aureus
• Streptococcus pyogenes
• Streptococcus pneumoniae

A risk factor for croup and recurrent croup is a family history of the illness.

Most cases of croup occur in the fall (often in October) or early winter, which coincides with parainfluenza type 1 activity.  

The diagnosis of croup is based on the presence of high-pitched, noisy breathing (stridor) and barking cough, especially during a period when one of the causative viruses is active in the community. 

Tests may be used to rule out other conditions, such as:

• Chest X-ray
• Blood tests
  • White blood cell (WBC)
  • Serum bicarbonate 
  • Blood urea nitrogen (BUN)
• Viral culture and/or rapid diagnostic tests that detect viral antigens 

Treatment for mild croup is aimed at relief of symptoms and can be treated at home. Home treatment for mild croup includes: 

• Humidifier/mist
• Fever reducers (antipyretics)
• Adequate fluid intake

Medical treatment for mild croup may include: 

• A single dose of oral dexamethasone 

Treatment for moderate to severe croup includes: 

• Nebulized epinephrine 
• Dexamethasone: oral if tolerated, intravenous (IV) if IV access has been established, or intramuscular (IM) if oral intake is not tolerated and IV access has not been established
• Nebulized budesonide is an alternative 
• Supplemental oxygen if needed
• Supportive care
• Humidified air or oxygen
• Fever reducers (antipyretics)
• Adequate fluid intake