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Cold and Flu Center

Croup and Coughing in a 4-Year-Old

author image Sriram Ramgopal
Sriram Ramgopal is a medical graduate from Sri Ramachandra University, India. He currently lives in the the greater Boston area and works as a Neurology Research Fellow at Children's Hospital, Boston. Ramgopal is also the co-founder of Sangam India, a nonprofit urban development organization based in Chennai, India.
Croup and Coughing in a 4-Year-Old
Symptoms of croup include runny nose, fever, noisy breathing and a seal-like cough. Photo Credit Goodshoot/Goodshoot/Getty Images

Croup, also called acute laryngotracheobronchitis, is a common upper airway infection in children. Croup can vary in severity from a mild cough to a severe obstruction of the airway. Treatment for croup depends on the severity and can range from mild symptomatic treatment to use of a breathing tube to maintain the airway. Complications of croup can lead to problems in the ear, epiglottis or the lower respiratory tract.

Croup Infection

Croup is due to an infection caused by parainfluenza viruses 1, 2 and 3, though other viruses and bacteria can also be the cause. According to the website for Nelson's Pediatrics, children are most susceptible to infection between 3 months and 5 years. Boys are more frequently affected and infections are common in the autumn. The virus infects the larynx, trachea and the major bronchi. The inflammation can cause swelling of the larynx, which can partially obstruct airflow. In severe cases, this can completely occlude the airway.


Before having the cough, children might have five to seven days of a sore throat, runny nose, mild cough and a low-grade fever. The word "croup" refers to the characteristic cough of the disease, which is high-pitched and sounds like a seal bark. Symptoms are worse at night and when the child cries. The fever can increase during this time. When the airway becomes narrowed, inspiration of air can produce a high-pitched whistling sound called stridor. Severely affected children are breathless and have a stridor that occurs during expiration as well.


The diagnosis of croup can be made easily in typical cases. Severely affected children have fever, noisy breathing and breathlessness. An X-ray might be needed to confirm the diagnosis and shows characteristic signs that are diagnostic. In severe cases, the epiglottis is affected, which can be seen by lowering the tongue. Doctors can also examine the child for complications of croup that can cause disease in the ear or in the lung.


Milder cases of croup can be treated at home with mist treatment. Mist should not be cooled. While cool mist might provide more symptomatic relief, it sometimes causes worsening of symptoms. In more severe cases of croup, children should be admitted to the hospital. A face mask is given to provide oxygen and to provide nebulized epinephrine, which helps to prevent narrowing of the airway. An oral steroid may also be given to reduce inflammation. Antibiotics are not needed in croup as it is frequently viral in origin. Children recover spontaneously over several days.

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