What Is Croup and Its Link to COVID-19 in Children?

With pediatric COVID cases, children may also present with croup symptoms.

  • Croup is a common pediatric infection of the upper respiratory system and comes with a characteristic harsh, barking cough.
  • COVID-19 infection can result in croup symptoms.
  • There are many ways to treat croup. You will want to seek medical attention if croup causes problems like severe breathing issues or prolonged symptoms.

Reports have indicated that children could have different COVID-19 symptoms than adults. Specifically, children who developed COVID-19 could also show signs of laryngotracheobronchitis, or croup.

Croup is a respiratory infection that often happens in young children but can happen to anyone. Viruses or bacteria cause croup, which is treatable and preventable.

The main symptom is a "barking" cough, often with a hoarse voice. The cough can be alarming—especially if it appears in a child with COVID-19. Here's what you need to know about croup cough and COVID-19.

Children Omicron Croup Cough , Mixed race preteen girl sneezes into her arm
Getty Images

Croup Symptoms and Causes

The most notable symptom of croup is a bark-like cough. Some people describe the cough as sounding like a seal barking. Croup also makes the voice hoarse.

Other symptoms can also show up with croup, including:

  • Fever
  • Rash
  • Eye redness
  • Swollen lymph nodes

Overall, symptoms of croup may last for a few days and are worse at nighttime.  

Croup can be alarming to hear, but it's not always dangerous. Still, croup can cause difficulty breathing if paired with another less-common symptom—stridor, or breathing that sounds like gasping.

Respiratory viruses, such as parainfluenza RSV, measles, adenovirus, and influenza, cause croup. In severe cases of croup, bacteria may be the cause.

How Is Croup Diagnosed?

A healthcare provider will ask about your child's medical history and do a physical exam. During the exam, the healthcare provider will listen for wheezing and watch for any breathing or breath sound issues.

Comorbid Conditions

Croup has comorbidities with other illnesses. One study published in 2015 found that some of the most common comorbidities include:

  • Upper respiratory infections
  • Pneumonia
  • Bronchitis
  • Bronchiolitis
  • Asthma

What Is Bronchiolitis?

Bronchiolitis is an infection that causes the airways in the lungs (bronchioles) to become inflamed and narrow.

What’s the Link Between Croup and COVID?

As the Omicron variant of COVID-19, specifically, surged throughout the United States, pediatric cases of the virus were on the rise. The reason why croup has been seen in children with COVID-19 may have a lot to do with two things: the body part that COVID-19 primarily affects and children's anatomy.

The Omicron and Delta variants more often cause mild upper respiratory issues than previous variants. Those issues include sore throats, runny noses, sneezing, and coughing.

Also, croup causes swelling of the voice box and the windpipe, or trachea. The swelling can cause children's airways to constrict more since their airways are smaller than in adults.

Treatments for Croup

Getting your child tested and isolated from other healthy family members is essential if they show any symptoms of croup and COVID-19.

Prescription medicines for croup might include glucocorticoids for mild cases or dexamethasone or epinephrine for moderate to severe cases. No specific over-the-counter (OTC) medicine is available to treat croup. Instead, remedies focus on household solutions. 

At-home remedies for croup include:

  • Use mist, either from a humidifier or from the steam of running hot water in the bathroom.
  • Allow the child to breathe cool air outside at night or use a cool air vaporizer.
  • Treat the cough with warm, clear fluids or frozen juice popsicles.
  • Keep the child's head elevated.

When To See a Healthcare Provider

Consult a healthcare provider if:

  • Your child has a fever that lasts more than three days
  • Croup symptoms last longer than a week
  • You have concerns about your child's condition

While croup does not usually turn severe, monitoring your child's breathing is essential. It's time to seek help from a healthcare provider if, at any point, your child begins noticeably working harder to breathe. They may look like they are using the muscles between their ribs to inhale, which is known as retraction.

Immediate medical attention is necessary if croup worsens. Hospitalization is the next step if croup symptoms get worse after treatment.

Usually, children require hospitalization in cases of oxygen therapy, severe dehydration, and the need for multiple epinephrine doses. Less than 5% of children with croup require hospitalization.

Other than your child having difficulty breathing, symptoms that require quick medical care include:

  • Pale or blue skin
  • Severe bouts of coughing
  • Drooling or problems swallowing
  • Problems talking or crying because of breathing issues

Call emergency medical services if your child experiences skin changes, agitation, breathing struggles, and extreme drowsiness.

How To Prevent Croup and COVID-19

Prevention is critical for the best health outcomes. Precautions such as proper handwashing lower the risk of spreading croup and COVID-19. Keeping children up-to-date on vaccines can protect against COVID-19. COVID-19 vaccines and booster shots are available for children 6 months and older.

Children aged 5 and older who have completed the Moderna or Pfizer-BioNTech primary series are eligible for a booster shot.

A Quick Review

Some children who develop COVID-19 can have croup symptoms. For the most part, croup is treatable at home. Consult a healthcare provider if symptoms worsen or last longer than one week. Precautions like proper handwashing and vaccines can help prevent croup and COVID-19.

Was this page helpful?
10 Sources
Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Brewster RC, Parsons C, Laird-Gion J, et al. Covid-19–associated croup in childrenPediatrics. 2022;149(6):e2022056492. doi:10.1542/peds.2022-056492

  2. MedlinePlus. Croup.

  3. MedlinePlus. Croup.

  4. Woods CR. Patient education: Croup in infants and children (beyond the basics). In: Armsby C, Messner AH, Kaplan, SL, eds. UpToDate. UpToDate; 2022.

  5. Lee DR, Lee CH, Won YK, et al. Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 Emergency Departments in KoreaKorean J Pediatr. 2015;58(10):380. doi:10.3345/kjp.2015.58.10.380

  6. MedlinePlus. Bronchiolitis.

  7. American Academy of Pediatrics. Children and COVID-19: State-level data report.

  8. Nakagawara K, Chubachi S, Namkoong H, et al. Impact of upper and lower respiratory symptoms on COVID-19 outcomes: A multicenter retrospective cohort studyRespiratory Research. 2022;23(1):315. doi:10.1186/s12931-022-02222-3

  9. Centers for Disease Control and Prevention. How to protect yourself and others.

  10. Centers for Disease Control and Prevention. Stay up to date with COVID-19 vaccines including boosters.

Related Articles