Is it COVID or Croup? It May Be Both
It’s no wonder that Susan Wu, MD, a hospitalist at Children’s Hospital Los Angeles, can do a spot-on impression of croup. She’s seeing, and hearing, a lot of it these days, as cases are rising. The culprit is COVID-19, which can trigger croup, characterized by inflammation just below the vocal cords that causes a hoarse voice, obstructed breathing, and a noisy cough that sounds like “a seal barking,” Dr. Wu says.
A condition that afflicts mostly young children, croup is usually a symptom of one of the common seasonal viruses, Dr. Wu says. But this winter the coronavirus gets most of the blame. We asked Dr. Wu to discuss how to respond to this unfortunate double whammy.
When did croup start presenting in kids with COVID-19?
We started seeing more croup in our hospitalized COVID patients over the holidays, when many were traveling and attending family gatherings. Last year we saw very few croup cases.
What age groups are impacted?
Croup presents primarily in kids ages 6 months to 5 years. This is critical because this age group is presently unable to be vaccinated for COVID-19. Parents must be vigilant about getting themselves vaccinated, and following masking and physical distancing, and keeping children isolated who present with symptoms until they can be tested for COVID-19.
What should parents do if they think their child has croup and COVID-19?
Croup is something that can—due to swelling of upper airways—block breathing. If your child is showing symptoms contact your pediatrician. Your child may need treatment, which is typically steroids. Your pediatrician can prescribe that. Some people feel that breathing moist air from a humidifier or from running hot water in the shower is helpful. If your child is having trouble breathing, or making a whistling or creaking noise when breathing, get immediate help at a hospital emergency department.
Does everyone who gets COVID-19, or one of the other viral infections, develop croup?
A virus can give some patients croup. Like with other seasonal cold viruses, one person might get croup and another person might just get a runny nose and cough, and another person might get pneumonia.
How long does croup last?
Usually it lasts about three days. That's kind of the peak time. And then it will get better after that.
Does coming down with croup while having COVID-19 cause any changes to the course of croup?
It seems to look the same in terms of how long it lasts, what it sounds like. We've been treating it the same, and it gets better with steroids. We’re seeing more kids in the hospital with croup, but we aren’t sure whether this is because COVID-related croup is more severe, or if it’s related to the high numbers of infections overall.
Could the return to school have caused the jump in croup numbers?
I really don't think so. The rise started during winter break when kids were not in school. And so if it was caused by school, I would expect that we would have started seeing more of a rise a couple weeks after school started. But it actually seemed to get a little bit better.
