4 Questions to Ask When Your Child Has Recurrent Croup

4 Questions to Ask When Your Child Has Recurrent Croup

Croup can be very scary for parents and children alike, but fortunately it usually sounds worse than it is. Croup is a viral infection that causes swelling or a partial blockage of air as it flows through the larynx, or voice box. The hallmarks of croup are stridor, a harsh, raspy noise when breathing in, and a bark-like noise when coughing.

Typically children recover from croup within a week and are usually easily managed. As children grow, their airways also grow, decreasing the frequency or occurrence of recurrent croup.

A relatively small subset of children may continue to have croup. Typically these children are managed effectively by their primary care doctor and don’t need further evaluation. However, there are a few circumstances in which we would recommend for a child to be examined by an otolaryngologist, or ENT (ear, nose and throat) doctor.

If your child has recurrent croup, it is important to rule out any underlying structural issues or narrowing of the airway, called subglottic stenosis. Here are some questions to ask yourself to help determine if your child’s recurrent croup needs to be evaluated by an ENT specialist:

  1. Are my child’s symptoms getting worse, not better?
    After the initial onset of croup, your child should start feeling better within a couple of days. If her symptoms continue to get worse with increased work of breathing or retractions (sucking in around the neck or ribs when she breathes in) this could be a sign that she needs to be evaluated.
  2. Am I taking my child to the Emergency Room frequently?
    For most children with croup, parents can care for their child with home treatments. If your child’s symptoms are continually necessitating a trip to the Emergency Room, this could be a sign that further investigation is warranted.
  3. Does my child need steroids more frequently?
    While the majority of children will not need steroids to treat croup, there are some that will. If you find that your child is needing steroids more frequently to overcome the symptoms of croup, this could indicate your child’s airway may be smaller than those of children his same age, and this warrants an evaluation by an ENT.
  4. Am I continuing to be concerned?
    If your child’s recurrent croup tends to escalate rather than get better after a few days, you’re making more trips to the ER, and she continually needs steroids to recover, your child could have an underlying structural issue that needs to be evaluated by an ENT. Again, this is a rare circumstance, but if you are continually worried, an appointment might be worth the peace of mind.

If you’ve answered yes to any of these questions, I recommend discussing your concerns with your child’s primary care provider. He or she may recommend a referral to an otolaryngologist. There your child will receive a thorough evaluation to look for structural abnormalities of his upper airway that could include an endoscopy of nose, throat, and vocal cords, x-ray of the neck, and bronchoscopy of airway.

If your child does have an underlying structural abnormality of his airway, there are a couple of paths we can take. One is watchful waiting and the other is surgery. Because every child’s situation and anatomy are a little bit different, we have to approach each child’s situation individually.

Even children with underlying structural issues as a cause for their recurrent croup can still outgrow subglottic stenosis. Only a small percentage of children with structural issues will need surgery to correct it.

If you have questions, or would like to request an appointment, please contact our Upper Airway Center. 

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Amy Myer, MSN, CNP

About the Author: Amy Myer, MSN, CNP

Amy Myer, MSN, CNP, has been a certified pediatric nurse practitioner in the division of Otolaryngology for the last 12 years. Currently she provides care across the continuum for pediatric patients with congenital and acquired anomalies of the aerodigestive tract at Cincinnati Children’s.

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  1. Marissa January 25, 02:47
    Hi, My daughter, now 8 1/2 years old has had reoccurring or chronic croup since she was around 6 month old. She gets it multiple times a year, sometimes up to 5 or 6 times in one year. Warm, moist air doesn’t touch it and cool air can minimally help, but she requires dexamethasone pretty much every time, to the point that her regular doctor was writing a script when I would call and then I’d have some left over for when the next bout would happen. She has been hospitalized for it 3 times. The last time she was hospitalized for it, was when she was about 5 1/2 to 6 years old and it was probably the worst I’ve seen her. She received dex and it didn’t touch her, racemic epi and it didn’t touch it.. she was lethargic and would fall back asleep as soon as you weren’t directly talking to her and actively asking her something. We were admitted from the urgent care, directly into the hospital for 2 days. I had never had a doctor tell me it could be something more than croup until this past year. What is the likelyhood that it is? I feel absolutely sick to my stomach that it could have always been something more this entire time, and I’ve done nothing... My third child, who was diagnosed with CHARGE Syndrome, was born with a TEF and EA and a host of other birth defects... Could this be something in my genetics that I passed down?
    • Amy Myer, MSN, CNP
      Amy Myer, MSN, CNP Author January 29, 10:28
      Hi Marissa, It is unlikely that you passed down croup to her daughter, especially if you don't have any other symptoms. Croup can happen to any child. If the episodes of croup are concerning, make your daughter feel scared, or you are unsure of what to do, it would be worthwhile to see an ENT. An ENT can evaluate her as well as have a treatment plan for when the symptoms start. This may also give you peace of mind.
  2. Jenn P. March 29, 10:00
    Although we have always been able to manage my son's croup symptoms, he has never grown out of it and will be 13 next month. He has had it 3 times within the last 6 months, so I guess we should have our ENT evaluate him. He has already had his tonsils and adenoids removed mostly because of chronic nosebleeds. So he is not stranger to the ENT.
  3. Matthew Myer April 08, 15:22
    How often would you say croup would have to occur for it to be recurrent? BTW Nice name, I never see Myer spelled my way
    • Amy Myer, MSN, CNP
      Amy Myer, MSN, CNP Author April 10, 07:25
      Hi Matthew, It is uncommon for kids to have more than 1-2 episodes of croup per year. If there are more than 2 episodes per year, that would be considered recurrent.