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.