Can you make the diagnosis?

Emily’s mom wakes up in the middle of the night.  She can hear her daughter Emily coughing in the next room, with a barking type of cough.  Emily, who is 2-years-old, has had a cold the last few days.  Emily starts crying, so her mom goes to check on her.

Emily is fussy and feels feverish.  Her coughing continues, and it looks like she is working to breathe.

Concerned, Emily’s mom decides to take her to the Emergency Department.

What does Emily have?

  1.  Pneumonia
  2.  Bronchitis
  3.  Croup
  4.  Allergic reaction


If you guessed 3.  Croup, you are correct!

Croup is a viral infection of the upper airway, and causes a barking-type cough.   Croup causes swelling around the upper airways.  Croup is most common in children younger than 5.  Other symptoms associated with croup include fever, hoarse voice, and noisy breathing.  Symptoms are usually worse at night time.

Croup can be treated at home in many situations, with humidified air, fever reduction, and giving the child fluids.  However if the child has severe symptoms such as noisy or labored breathing, drooling, seems either agitated or fatigued, has skin color changes such as glue or grayish tone, or can not take fluids by mouth then they must be seen medically.  Treatment can include humidified breathing treatments, steroids, and in some situations epinephrine which is also given as a breathing treatment.

Bronchitis, which is inflammation of the lung passages, is a possibility, as it is often associated with cold symptoms.  However bronchitis does not usually have the barking cough associated with croup.  Pneumonia is also a possibility, and can be diagnosed by physical exam, as congestion in the lungs can be heard with a stethoscope, or identified on a chest x-ray.  Allergic reaction is less likely in this case, as Emily’s cough is associated with a cold, she has a fever, and she does not have a rash.



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