Croup and tracheitis in children: symptoms and what to do

Few things are more frightening for a parent than waking at night to hear their child coughing like a barking dog and struggling to breathe. Croup and tracheitis are common respiratory illnesses of early childhood. Most cases can be managed well at home, but it is important to recognise the warning signs. In this article we summarise the most important things to know.

What is croup?

Croup (viral croup, laryngotracheitis) is a viral inflammation of the larynx and the upper part of the windpipe. Children's airways are much narrower than adults', so even a little swelling can make breathing considerably harder. It most often occurs between 6 months and 3 years of age, usually in autumn and winter, after a cold.

Typical symptoms of croup

• a "barking", seal-like dry cough,
• hoarseness,
• a high-pitched, harsh sound when breathing in (stridor),
• symptoms typically worsen suddenly at night,
• a mild fever, a runny nose beforehand.

What is tracheitis?

Tracheitis is inflammation of the lining of the windpipe, often developing as a complication of a cold. Its typical symptoms are a dry, tormenting cough that often lasts for days, pain behind the breastbone and feeling unwell, sometimes with a slight temperature. In most cases it is caused by a virus, but rarely a secondary bacterial infection can develop, which comes with high fever and a serious condition and needs immediate medical care.

What can you do at home for mild croup?

• Stay calm, and reassure your child: crying and fear make breathing worse.
• Sit them up and hold them on your lap in an upright position.
• Many find that cool, fresh air (an open window, or briefly stepping out onto the balcony well wrapped up) eases the symptoms.
• Give small sips of fluid.
• Manage fever as instructed by your paediatrician.

If your child has had croup before, ask the paediatrician what to do next time. They often prescribe medication to keep at home.

When to call an ambulance (112) immediately

• if your child is breathing with a high-pitched noise or with effort even at rest,
• if the skin between the ribs or above the breastbone sucks in when breathing in,
• if the lips or the area around the mouth turn bluish-grey,
• if they are drooling, cannot swallow, or sit leaning forward,
• if they have a high fever and are very weak, drowsy or restless,
• if the symptoms do not ease within a few minutes, or keep getting worse.

These signs may indicate serious narrowing of the airway, and you must not wait.

Prevention

Croup and tracheitis are most often complications of a viral infection, so prevention starts with protecting against infections: frequent handwashing, keeping sick siblings and family members apart, a smoke-free home, and the mandatory and recommended vaccinations. Appropriate humidity of 40–60% and regular airing also help keep the airways healthy.

And salt therapy?

Salt therapy is not appropriate during acute croup or tracheitis. During the illness your child needs rest and, if necessary, medical care. A dry salt climate can also irritate inflamed airways.

Many parents use a salt climate as a complement after recovery, for children prone to recurring respiratory complaints, because their child enjoys it. Its effectiveness has not been confirmed by large studies, so always discuss it with your paediatrician. Details: Salt therapy for children.

This article is for general information only and does not replace medical diagnosis or treatment. If your child has difficulty breathing, see a doctor, and in an emergency call 112.