What is the difference between croup and bronchiolitis?

What is Croup and Bronchiolitis?

Viral croup and bronchiolitis are common respiratory infections in young children. Unlike the usual coughs and colds, the inflammation in the airway associated with croup and bronchiolitis can often be significant, causing noisy and difficulty breathing. Croup affects the upper airway, and bronchiolitis the lower airway/bronchioles.  

What is croup?

Croup is a viral respiratory infection of the upper airway, which causes swelling of the voice box (larynx) and windpipe (trachea). The swelling causes a narrowing of the airway, which causes noisy breathing and a hoarse voice. The cough is described as a “barking” cough. It can cause difficulty breathing if left untreated. 

What are the symptoms of croup?

The onset of croup generally starts like any other respiratory infection with mild symptoms of runny nose, congestion, and fever. Typically, croup is a mild illness, and most children with croup are better in a few days. 

However, croup can get worse quickly, especially in the younger child, as their airways are smaller. Children often suffer from worsening symptoms in the evening, and a croupy cough develops. The hallmark of croup is a hoarse and distinct cough that is harsh, high-pitched like a seal barking. The high-pitched or squeaking noise when breathing in is referred to as stridor. The child might also have an increase in effort when breathing in, and you might see the skin between the ribs pull in when breathing. Symptoms tend to wax and wane, improving somewhat by the morning and worsening in the evening. 

What age do children typically get croup? 

Croup tends to occur in children between 3 months to five years old, but it can occur at any age. In some children, croup tends to reoccur.

What is the difference between croup and bronchiolitis?

In contrast to croup, bronchiolitis is characterized by inflammation of the lower airway/bronchioles. The narrowing or congestion of the bronchioles produces wheezing, a high-pitched whistling sound when breathing out and labored breathing.

Bronchiolitis affects young children under the age of two, most commonly in babies three to six months old. However, some babies are at risk for severe bronchiolitis, including those born prematurely with a chronic heart or lung disease.

How long does croup or bronchiolitis last?

Croup typically lasts four to five days but may last up to a week. 

Bronchiolitis usually lasts about two weeks, though a persistent cough can last several weeks in severe cases. Typically, day 3-4 of the illness is the worst. Therefore, we would expect a child to be turning a corner on day four and generally improving. 

How do children get croup or bronchiolitis?

Croup and bronchiolitis are contagious like other respiratory infections, spreading through direct contact with respiratory secretions. Thus, basic hygiene is essential in helping limit the spread of these illnesses.

What is the treatment for both?

Both croup and bronchiolitis are often mild illnesses and can be managed at home.

  • Encourage hydration with plenty of fluids.
  • Nasal saline rinse or saline sprays, especially before feedings in infants.
  • Antipyretics (Paracetamol & Ibuprofen) for comfort relief of fever
  • Cold and cough medications and antihistamines are generally not helpful.

For croup, some children may benefit from steroids to promptly relieve mild symptoms, while additional aerosolized treatment is necessary for the more moderate and severe illness. Sometimes a child with either croup or bronchiolitis may need a short hospital stay for observation, oxygen or hydration support.

When to call your doctor or get immediate medical care

Due to airway inflammation, both croup and bronchiolitis can make children feel miserable and quite ill.  Therefore, it is important to keep a close eye and seek help urgently if your child develops noisy or labored/difficulty breathing appears tire and lethargy or is not drinking well and appears dehydrated.

Dr Gina Dahel is based at IMC Children’s Clinic. Call 6887 4440 to make an appointment.

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