How to Treat Croup

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What is Croup?

Croup (or laryngotracheobronchitis) is a common respiratory issue that mostly affects infants and young children. It’s known for its “barking” cough, which happens due to inflammation in the voice box (larynx) and windpipe (trachea). Most cases are mild and can be treated at home, but it’s still important to keep a close eye on symptoms, as more serious cases may need medical care.

What Causes Croup?

Croup isn’t a virus or bacteria on its own. Instead, it’s a temporary condition usually brought on by a viral infection. A number of common viruses can trigger it, like the flu, parainfluenza, RSV, measles, or adenovirus. When it comes to treating croup, the main goal is to support your child’s immune system and help them breathe more easily while the illness runs its course.

As mentioned above, the most common sign of croup is a "barking" cough, like below:

https://www.youtube.com/watch?v=sZrrtC7Pj6I

When to Seek Medical Attention

Most cases of croup can be treated at home, but with any respiratory illnesses it's important to know how to spot signs of respiratory distress. Read this article.

• Chest Retractions

• Lethargy 

• Low Pulse Ox

• Blue Lips or Extremities 

• Excessive Drooling or Inability to Swallow

• Apnea (long pauses in breathing)

• Not able to cry or talk from difficulty breathing

• Stridor at rest (even when calm and not crying) - see more below

Stridor is a high-pitched, harsh, or squeaky sound that occurs when a person breathes—most often on inhalation (breathing in). It’s caused by narrowing or obstruction of the upper airway, which includes the throat, voice box, or windpipe.

Croup is one of the leading causes of stridor in children. If it occurs only with activity or crying, it can most times be treated at home. However, if it persists at rest or accompanied by chest retractions seek medical attention.

https://www.youtube.com/watch?v=JSdEK79J4dw

Treating Croup at Home

Cool Air:

Cool air can provide relief from croup symptoms. Depending on the time of year, you can step outside or take a few breaths from the freezer.

Steam Inhalation:

Cool air is usually more effective, but some children may find relief from steam inhalation.

Humidifiers:

Humidifiers add moisture to dry air, which may help soothe the irritated airway and ease breathing. Maintaining humidity in the range of 40-60% can also reduce transmission of pathogens.

Elevate Head & Shoulders When Sleeping:

To help ease breathing for a child with croup, it can be beneficial for them to sleep with their head and upper body slightly elevated. You can do this by adding extra pillows or gently raising one end of their mattress or bed. (Babies under 12 months should always sleep flat on their backs for safety)

Homeopathy: Spongia Toasta:

Spongia tosta is a homeopathic remedy made from roasted natural sea sponge. In homeopathy, it's commonly used to support respiratory issues—especially dry, barking coughs that are often associated with croup.

Chest Rubs (non-petroleum based):

Can help ease coughing and open airways

• Zarbees Chest Rub

• Wellments

• Maty’s Kids and Adults

• Maty’s for Babies

• Boogie Chest Rub

• Earthley Breathe Well Salve (code: ALEXK10)

• Hyland’s chest rub

Rest

Your body heals when it sleeps, so if you follow a strict sleep schedule don’t hesitate to throw it out. Let your child nap longer than usual, go to bed earlier if needed, sleep in, etc. Resting allows the body to focus all its energy on healing, cleansing toxins, and immune support. If a fever is keeping your child up at night, that would be a time where you could consider medication if you feel that their body needs to rest and reset. But there are many things you can try beforehand. Check out my 45-page fever guide.

Hydration

Hydration is so important when sick, especially if experiencing fever, vomiting, or diarrhea. Add in electrolytes as needed! If having extended vomiting or diarrhea without adequate re-hydration, call your pediatrician. You want to avoid severe dehydration.

Support the immune system

Read this article

Soothing the Throat

• A spoonful of honey if over 12mo

• Wam liquids: teas broths

• Bee Keeper Natural's Throat Pops

Why Cough Suppressants are Not Ideal

In general, coughing serves a purpose in the body's natural healing process. A productive (wet) cough is your body's way of clearing out mucus, pathogens, and debris from the lungs and airways. Suppressing that natural reflex can trap mucus in the lungs, increasing the risk of infection like pneumonia or bronchitis.

When it comes to croup, the "barking" cough is caused by inflammation and swelling in the upper airway (specifically the larynx and trachea). Suppressing that cough doesn't treat the swelling - it just hides the symptom while the airway can continue to narrow, making breathing more difficult.

Croup can cause stridor (a high-pitched sound during inhalation), and labored breathing. If the cough is suppressed, it may be harder to assess how severe the airway obstruction is - delaying treatment when it's needed most.

In addition, most croup cases occur in children under 5 years old - the same age group cough suppressants (especially those containing dextromethorphan or codeine) are not recommended.

If Croup is Accompanied by Fever

A fever is a natural response to an infection or illness. It is a good sign, because it means that your body is fighting off the infection. The increased body temperature from a fever boosts the performance of immune cells and induces stress on pathogens and infected cells, providing a strong immune defense.

Since fevers are the body’s natural way of fighting off illnesses, reducing a fever can actually prolong the illness or infection. Fevers also trigger immune cells to recruit and activate T-cells, which coordinate long-term “adaptive” immune responses such as antibody production. By letting a fever run its course, you are also providing better protection for future illnesses.

Check out my 45-page fever guide.

If Fever Medication is Necessary

Medicating a fevering child is up to parents’ discretion as a last resort after supportive care. You can try to reduce the fever if your child is unable to eat, drink, or sleep due to discomfort from the fever.

Ibuprofen (Motrin) or Acetaminophen (Tylenol)

Acetaminophen (Tylenol) lowers glutathione stores - an antioxidant very important in immune function. By lowering this antioxidant, we are prolonging the illness. 

Ibuprofen (Motrin) does lower glutathione, but not to the extent that Tylenol does. If choosing to medicate, try Ibuprofen first (in children over 6 months old). If the fever is still not going down, and you think you may need to head to the ER, then you can try Acetaminophen as a last resort.

Conventional Croup Treatments

• Steroids like dexamethasone or prednisolone to decrease airway swelling

• Breathing treatments with epinephrine (typically used for severe cases to quickly reduce swelling in the airways)

• Antibiotics are NOT helpful for croup, because it’s typically caused by a virus rather than bacteria