Croup and Its Link to COVID in Children?

• Croup is a common pediatric infection of the upper respiratory system and comes with a characteristic harsh, barking cough.
• It’s a symptom that can happen alongside COVID because they can both result in upper respiratory issues.
• There are many ways to treat croup, though you’ll want to seek medical attention if croup comes with problems like severe breathing issues or prolonged symptoms.

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

Croup is a respiratory infection that often happens in young children but can happen to anyone. It can be caused by viruses or bacteria but is treatable and can be prevented.

The main symptom is a “barking” cough, which often comes with a hoarse voice. The cough can be alarming—especially if it shows up in a child diagnosed with COVID. Here’s what you need to know about croup cough and COVID.

Croup symptoms and causes

The most notable symptom of croup is a bark-like cough, which is sometimes described as seal barking. Croup also makes the voice hoarse. Other symptoms can also show up with croup, including fever, rash, eye redness and 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. When it’s paired with another less-common croup symptom—stridor, or breathing that sounds like gasping—it can cause difficulty breathing.

The condition is caused by respiratory viruses such as parainfluenza RSV, measles, adenovirus and influenza. In serious cases of the condition, bacteria may be the cause.

How is croup diagnosed?

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

Comorbid conditions

Croup has comorbidities with other illnesses. One study found that the most common comorbidities were:

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

What is bronchiolitis? Bronchiolitis is an infection that causes the airways in your lungs (bronchioles) to become inflamed and narrow.

What’s the link between croup and COVID?

As the Omicron variant of COVID, specifically, surged throughout the country, pediatric cases of the virus were on the rise. The reason why croup has been seen in pediatric COVID patients may have a lot to do with two things: the part of the body affected most by COVID and children’s anatomy.

The COVID Omicron variant, as well as the Delta one, was more often associated with mild upper respiratory issues. These issues can include symptoms such as sore throats, runny noses, sneezing and coughing.

Also, croup causes swelling of the voice box and the windpipe, which are part of the upper respiratory tract. The swelling that happens can cause children’s airways to constrict more because their airways are smaller.

Treatments for croup

If your child begins showing any symptoms of croup, and potential signs of COVID, it’s important to get them tested and isolated from other well family members if they receive a positive result.

Prescription medications for croup might include glucocorticoids for mild cases of croup or dexamethasone or epinephrine for moderate to severe croup. Also, there’s no specific over-the-counter medication used to treat croup, so remedies tend to focus more on household solutions. These are remedies such as:

• Using mist, either from a humidifier or from the steam of running hot water in the bathroom
• Allowing the child to breathe in outside cool air at night or using a cool air vaporizer
• Treating the cough with warm, clear fluids or frozen juice popsicles
• Keeping the child’s head elevated

When to see a healthcare provider

You should also consult with a healthcare provider if:

• Your child has a fever for more than three days
• Croup symptoms last longer than a week
• You have concerns about the condition of your child

While croup doesn’t usually turn severe, it’s important to monitor your child’s breathing. It’s time to seek help from a healthcare provider if at any point they begin noticeably working harder to breathe. This might look like using the muscles between their ribs or above their neck to inhale, known as retraction.

Immediate medical attention is necessary for situations where croup has worsened. If croup symptoms get worse after treatment, hospitalization is the next step.

Hospitalization will also usually be required in cases of oxygen safety monitoring, severe dehydration and the need for multiple epinephrine doses. However, less than 5% of croup cases in children 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

Of note, if your child experiences skin changes, agitation, breathing struggles and extreme drowsiness, call emergency medical services rather than taking them for care.

How to prevent croup—and COVID

Prevention is still key to the best health outcomes. That means taking precautions such as proper handwashing to lower the risk of spreading croup and COVID.

Also, keeping children up-to-date on vaccines can be protective against COVID. COVID vaccines are available for children 6 months and older. Booster shots are available for children 5 or older if they are able to receive them.