Croup or COVID-19? The Omicron Variant is Mimicking Another Common Childhood Illness
COVID-19 in babies and young children can sometimes mimic the characteristic symptoms of the upper-respiratory infection known as croup: Barky cough and whistly breathing sound.
That’s why your pediatrician might be recommending that patients with croup get COVID-19 tested to find out whether the SARS-CoV-2 virus caused the illness.
“Not every child with croup has COVID, but we have to have a high suspicion given the surge” of the omicron variant, said Bianka Soria-Olmos, D.O., with Cook Children’s Pediatrics Haslet. “Croup is around; that is common during the winter months. But the new association with COVID-19 has recently been described. Pediatricians are on heightened alert.”
Croup is an airway inflammation often caused by a parainfluenza virus. It’s a common illness from ages six months to 5 years, and it usually can be treated at home. Dr. Soria-Olmos said some of her patients with the croup cough have been testing positive for COVID-19.
Parainfluenza or COVID-19? Why does it matter which virus causes the croup? Because doctors say parents need to isolate and watch for other symptoms if their child has COVID-19. As of Thursday, 40 patients were being treated for COVID-19 at Cook Children’s Medical Center, including nine patients in the pediatric intensive care unit. At the peak in mid-January 2022, more patients were hospitalized with COVID-19 at Cook Children’s than at any point of the pandemic.
Dr. Soria-Olmos said croup tends to affect young children because of their smaller airways. The 4 and under age group, for now, remains ineligible for COVID-19 vaccines.
As the omicron variant spread, media reports in recent weeks have cited a link between COVID-19 and croup. One explanation could be that omicron is believed to settle higher in the respiratory tract.
“It sounds like omicron is doing this where the other variants weren’t presenting in that fashion,” she said. “In my mind it’s COVID croup versus the old-fashioned croup. I cannot tell the difference between the two by examining the child. The only way to tell the difference is by testing.”
What strikes Dr. Soria-Olmos about recent cases among her young patients isn’t the amount of croup but the positive COVID-19 test results. She urges parents to seek out COVID-19 testing if their child starts with the distinctive barky cough.
“Knowledge is power. Identifying the cause really does help in the situation that we’re living in right now. Hopefully that will persuade people to know that testing isn’t a bad thing. It’s one of the tools we have to start flattening the COVID positive case curve.”
Like Dr. Soria-Olmos, Todd Johnson, M.D., at the new Cook Children’s Pediatrics Allen has treated children whose croup turned out to be a COVID-19 infection. He also recommends a COVID-19 test for croupy children so that the parents can better anticipate what to expect if the test turns out positive.
“Then they’re able to know, ‘How long do I have to stay home? How long do I have to stay out of work? How long do I avoid family members who might have complex medical issues?’”
Some of COVID-19’s symptoms might look like croup – but with the potential for other ailments too, such as vomiting, diarrhea, body aches, sore throat, prolonged fever and loss of taste and smell. Recovering from COVID-19 can take longer than getting over typical croup, Dr. Johnson pointed out.
The father of seven children, Dr. Johnson knows firsthand how scary the barky or seal-like cough seems to a parent. He explained that croup causes inflammation in the soft tissue below the vocal cords.
“When that swelling happens, it narrows the airway to the point that makes that musical sound of the high-pitched whistle during the day, and that really barky cough at night.”
The daytime fever, dry cough and runny nose that’s characteristic of mild croup can be treated conservatively with over-the-counter medications. Although a barky cough at night is typical of mild croup in young children, Dr. Johnson recommended they be evaluated by their pediatrician. One dose of an oral steroid given at the time of their visit will help reduce the airway swelling, alleviate the nighttime cough and lead to a smoother recovery.
“Whether it’s croup related to parainfluenza or the omicron or the delta variant, the children still need to be hydrated. With the fevers, they tend lose more fluids. They need fever reducers if the fever’s high and they’re irritable and not drinking and eating as well,” he advised.
Meanwhile, children with stridor (the whistly sound on an inhale) or a barky cough during the daytime, difficulty breathing, abnormal drooling or severe agitation need to be seen urgently, Dr. Johnson said. An urgent care or ER physician may recommend closer monitoring and potentially an inhaled treatment that can only be administered in a health care setting.
Meet Dr. Todd Johnson
As a missionary in Rio de Janeiro in 1995, Dr. Johnson 
discovered a passion for children’s advocacy while volunteering in a Brazilian orphanage. He went on to do undergraduate training at Brigham Young University in Nutritional Science, medical training at Texas A&M College of Medicine and pediatric residency at Helen Devos Children’s Hospital in Grand Rapids, Mich. His background as an assistant professor of pediatric medicine and in pediatric urgent care provided experience in child development, injury diagnosis and treatment, management of medical emergencies and routine pediatric illness.
Dr. Johnson found his dream job at Cook Children’s Allen, where he takes a partnership approach to keeping kids healthy. “I value working alongside the family to understand their needs and help them sift through medical information,” he said. “As a father of seven children, I understand the importance of having someone to support you through your child’s growth, illness and health challenges.”
Dr. Johnson enjoys time with his wife and their children and favorite hobbies: exploring RV campsites, road and mountain biking, reading, gardening and playing the piano.
Cook Children’s Pediatrics Allen is located at 1710 N. Greenville Ave, Suite 110. Schedule an appointment with Dr. Johnson here.
Location | Cook Children's Pediatrics Allen (cookchildrens.org)
Get to know Bianka Soria-Olmos, D.O.
Dr. Soria-Olmos is a Cook Children's pediatrician in Haslet. She was born and raised in Fort Worth, Texas, so Cook Children's has always had a special place in her heart. She came to know Cook Children's when she was just a kid herself. She went to the medical center a number of times with her active younger brother, who needed care following several mishaps with broken bones. The visits inspired her to decide, "I want to be a Cook Children’s doctor one day."
In pursuit of her dream, Dr. Soria-Olmos attended Texas Christian University (TCU) for a degree in biology and to fulfill the pre-medical school requirements. After graduating from TCU, she chose to stay local and attended medical school at the University of North Texas Health Science Center/Texas College of Osteopathic Medicine in Fort Worth. She completed part of her pediatric clerkship at Cook Children's, learning about pediatric medicine by attending rounds with pediatric hospitalists. It was then she knew she wanted to be a pediatrician.
She began her career with Cook Children's in 2014 as a pediatric hospitalist caring for sick children admitted to the hospital. Today, she works at Cook Children's primary care office in Haslet. Her special interests include child safety, child development and asthma.
