Acute Laryngotracheitis

Symptoms

Common signs and symptoms of Acute Laryngotracheitis include:

Harsh, barking cough that sounds like a seal

Hoarse or raspy voice

Noisy, high-pitched breathing when inhaling (stridor)

Difficulty breathing or working harder to breathe

Fever, typically low-grade

Runny or stuffy nose

Symptoms worse at night or when crying

Restlessness or irritability

Loss of appetite

Drooling or difficulty swallowing

Pulling in of skin around ribs when breathing

Fatigue or decreased activity level

When to see a doctor

If you experience severe or worsening symptoms, seek immediate medical attention. Always consult with a healthcare professional for proper diagnosis and treatment.

Causes & Risk Factors

Several factors can contribute to Acute Laryngotracheitis.

Acute laryngotracheitis is almost always caused by viral infections, with parainfluenza viruses being the most common culprits.

Acute laryngotracheitis is almost always caused by viral infections, with parainfluenza viruses being the most common culprits. These viruses typically start by causing cold-like symptoms in the nose and throat before spreading downward to infect the larynx and upper trachea. Other viruses that can trigger croup include respiratory syncytial virus (RSV), rhinoviruses, adenoviruses, and occasionally influenza viruses.

The infection causes inflammation and swelling of the tissues around the vocal cords and in the windpipe.

The infection causes inflammation and swelling of the tissues around the vocal cords and in the windpipe. In young children, even a small amount of swelling can significantly narrow the airway because their breathing passages are naturally much smaller than those of adults. Think of it like partially blocking a straw - a small obstruction has a much bigger impact on airflow in a narrow tube than in a wide one.

While viral infections cause the vast majority of croup cases, bacterial infections can occasionally be responsible, though this is much less common.

While viral infections cause the vast majority of croup cases, bacterial infections can occasionally be responsible, though this is much less common. Bacterial croup tends to be more severe and may require antibiotic treatment. Very rarely, allergic reactions, acid reflux, or inhaling irritants can cause similar symptoms, but these cases are distinctly different from typical viral croup.

Risk Factors

Age between 6 months and 6 years old
Being male (boys affected more than girls)
Having a history of previous croup episodes
Exposure to other children with respiratory infections
Attending daycare or preschool
Having a family history of croup
Being born prematurely
Having underlying airway abnormalities
Seasonal timing (fall and early winter)
Living in crowded conditions

Diagnosis

How healthcare professionals diagnose Acute Laryngotracheitis:

1
Doctors can usually diagnose croup based on the distinctive barking cough and breathing sounds without needing extensive testing.
Doctors can usually diagnose croup based on the distinctive barking cough and breathing sounds without needing extensive testing. During the examination, the physician will listen carefully to the child's breathing, looking for the characteristic high-pitched sound (stridor) that occurs when air flows through the narrowed airway. They'll also assess how hard the child is working to breathe and check for signs of respiratory distress.
2
The medical history and physical examination typically provide all the information needed for diagnosis.
The medical history and physical examination typically provide all the information needed for diagnosis. However, if the symptoms are severe or atypical, doctors might order additional tests. A neck X-ray can sometimes show the classic "steeple sign" - a narrowing of the airway that looks like a church steeple on the image. This test is usually reserved for cases where the diagnosis is unclear or when doctors need to rule out other conditions.
3
Doctors must distinguish croup from other conditions that can cause similar breathing difficulties.
Doctors must distinguish croup from other conditions that can cause similar breathing difficulties. These include epiglottitis (a more serious infection), bacterial tracheitis, foreign body aspiration, or allergic reactions. The characteristic barking cough, gradual onset, and the child's ability to speak or cry (even if hoarsely) help differentiate croup from these more serious conditions that require immediate emergency treatment.

Complications

Most children recover from croup completely without any lasting effects.
However, in rare cases, the airway swelling can become severe enough to cause significant breathing difficulties requiring emergency medical treatment.
Signs of severe croup include persistent stridor even at rest, severe difficulty breathing, inability to speak or cry due to breathing problems, or bluish coloring around the mouth or fingernails.
Secondary bacterial infections can occasionally develop, though this is uncommon.
Pneumonia might develop if the infection spreads to the lungs, and very rarely, bacterial tracheitis can occur as a complication.
Some children may experience recurrent episodes of croup, particularly those with underlying airway abnormalities or a strong family history of the condition.
While recurrent croup can be concerning for parents, most children eventually outgrow this tendency as their airways mature and grow larger.

Prevention

Preventing croup largely involves the same strategies used to prevent other viral respiratory infections.
Regular handwashing is one of the most effective measures, especially during cold and flu season.
Teaching children to wash their hands frequently and avoid touching their faces can significantly reduce the spread of viruses that cause croup.
Keeping children away from others who are obviously ill, when possible, helps limit exposure to croup-causing viruses.
However, since people can be contagious before symptoms appear, complete prevention isn't always realistic.
Ensuring children receive recommended vaccinations, including the annual flu shot, can help prevent some viral infections that might lead to croup.
Maintaining good overall health through adequate sleep, proper nutrition, and regular exercise helps support the immune system's ability to fight off infections.
While these measures can't guarantee prevention of croup, they may help reduce the severity of symptoms if infection does occur.
Parents should also be aware that children who have had croup once are more likely to develop it again, so staying vigilant during respiratory illness seasons is particularly wise for these families.

Treatment Approaches

Most children with croup can be treated safely at home with simple comfort measures and close monitoring.

Most children with croup can be treated safely at home with simple comfort measures and close monitoring. Cool, moist air often provides significant relief - many parents find that taking their child into a steamy bathroom or stepping outside into cool night air can quickly improve breathing. Running a cool-mist humidifier in the child's bedroom or having them breathe steam from a hot shower (while staying safely away from hot water) can help reduce airway swelling.

For moderate to severe cases, doctors may prescribe oral corticosteroids, typically dexamethasone or prednisolone.

For moderate to severe cases, doctors may prescribe oral corticosteroids, typically dexamethasone or prednisolone. These anti-inflammatory medications can significantly reduce airway swelling and improve breathing within hours. A single dose is often sufficient, though sometimes a short course may be needed. The medication is generally very safe and can prevent the need for hospitalization in many cases.

MedicationAnti-inflammatory

In emergency situations where breathing is severely compromised, nebulized epinephrine may be administered in a hospital setting.

In emergency situations where breathing is severely compromised, nebulized epinephrine may be administered in a hospital setting. This treatment provides rapid but temporary relief of airway swelling. Children who receive epinephrine typically need observation for several hours since the effects wear off and symptoms can return. Severe cases may require hospitalization for monitoring and supportive care, including supplemental oxygen.

Antibiotics are not effective for typical viral croup and are only prescribed in rare cases where a bacterial infection is suspected.

Antibiotics are not effective for typical viral croup and are only prescribed in rare cases where a bacterial infection is suspected. Pain relievers like acetaminophen or ibuprofen can help with fever and discomfort, but cough suppressants are generally not recommended as coughing helps clear secretions from the airway.

Antibiotic

Living With Acute Laryngotracheitis

When caring for a child with croup at home, creating a calm environment is essential since crying and agitation can worsen breathing difficulties. Keep the child comfortable and well-hydrated, offering small, frequent sips of cool liquids. Many children find it easier to breathe when sitting upright rather than lying flat, so propping them up with pillows during rest can be helpful.

Parents should know when to seek immediate medical attention.Parents should know when to seek immediate medical attention. Call emergency services if the child has severe difficulty breathing, makes high-pitched sounds when breathing at rest, cannot speak or cry due to breathing problems, drools excessively, or appears bluish around the lips or fingernails. Also seek immediate care if the child seems unusually drowsy or has trouble staying awake.

For families dealing with recurrent croup episodes, having a plan in place can reduce anxiety and improve outcomes.For families dealing with recurrent croup episodes, having a plan in place can reduce anxiety and improve outcomes. This might include: - Keeping a cool-mist humidifier readily available - Having your doctor's contact information easily accessible - Knowing the signs that require emergency care - Understanding that symptoms typically worsen at night - Preparing other family members for what to expect Most children outgrow their susceptibility to croup by school age as their airways mature and enlarge.

Latest Medical Developments

Latest medical developments are being researched.

Frequently Asked Questions

Is croup contagious and when can my child return to daycare?

Yes, croup is contagious since it's caused by viruses that spread through respiratory droplets. Children are most contagious during the first few days of illness when they have fever. They can typically return to daycare once they've been fever-free for 24 hours and are feeling well enough to participate in normal activities.

Why does croup seem worse at night?

Croup symptoms often worsen at night because lying flat can increase swelling in the airways, and cooler night air can trigger airway narrowing. Additionally, natural hormone changes that occur during sleep can affect inflammation levels. Many parents notice symptoms improve somewhat during the day only to return in the evening.

Should I use a warm or cool mist humidifier?

Cool mist humidifiers are generally recommended for croup because they add moisture without the risk of burns from hot water. However, some children respond well to breathing steam from a hot shower (while staying safely away from the water). The key is adding moisture to help reduce airway swelling.

Can adults get croup?

Adults rarely develop croup because their airways are much larger than children's airways. The same viruses that cause croup in children typically just cause cold symptoms in adults since the airway swelling isn't significant enough to cause the characteristic barking cough and breathing difficulties.

How long does the barking cough last?

The distinctive barking cough usually lasts 3-7 days, with the worst symptoms typically occurring in the first 2-3 days. Some children may have a lingering mild cough for up to a week after other symptoms resolve. If the harsh cough persists beyond a week or worsens, consult your doctor.

Is it safe to give my child cough medicine for croup?

Cough suppressants are generally not recommended for croup because coughing helps clear secretions from the airways. Over-the-counter cough medicines can also cause drowsiness, making it harder to monitor breathing. Stick to comfort measures like humidified air and consult your doctor about appropriate medications.

What's the difference between croup and whooping cough?

Croup causes a harsh, barking cough and typically affects young children with gradual onset. Whooping cough causes violent coughing fits followed by a high-pitched "whoop" sound and can affect people of any age. Whooping cough is bacterial and much more serious, requiring antibiotic treatment.

Can my child exercise or play normally with croup?

Children with croup should rest and avoid strenuous activities that might worsen breathing difficulties. Gentle, quiet activities are fine, but running or active play can increase breathing demands and potentially trigger more severe symptoms. Let your child's comfort level guide their activity.

Will my child develop croup again?

Some children are prone to recurrent croup episodes, especially those with smaller airways or family history of croup. Most children outgrow this tendency by age 6-8 as their airways mature. Having croup once doesn't guarantee it will happen again, but it does increase the likelihood slightly.

When should I call the doctor versus going to the emergency room?

Call your doctor for mild to moderate symptoms, persistent fever, or if you're concerned about your child's condition. Go to the emergency room immediately if your child has severe breathing difficulty, cannot speak due to breathing problems, makes loud breathing sounds at rest, appears bluish around the lips, or seems unusually drowsy.

Update History

Mar 16, 2026v1.0.0

Published page overview and treatments by DiseaseDirectory