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.

I think it’s really important to know the difference – one is fairly common, and the other is much more rare – and can be deadly.

Croup is a common viral infection I see daily. It is caused by a virus, and can cause a high fever, runny nose, sore throat, and cough.

It can be scary sounding, and can show up out of nowhere. Your kiddo will SEAL BARK when they cough – it really does sound just like a seal. I can often hear it and diagnose it in the waiting room!

This virus makes the area around the voice box and the windpipe swell up. This makes them hoarse, and sometimes they have loud breathing with inhalation.

We treat it with comfort – kids often get scared of their own breathing and cough sounds, and it really makes their throat hurt – so give them ibuprofen or Tylenol, steamy showers, cool humidified air, popsicles, cold drinks. Your doc may prescribe steroids for it if they seem particularly hoarse or loud with breathing.

Most kiddos with croup do just fine at home – and they can get it more than once. However, very rarely the swelling of the windpipe is severe. If they are having a hard time breathing, seem short of breath, lethargic, won’t drink, some kids have to be seen at the hospital for support, breathing treatments, and care.

Whooping cough, or Pertussis, is a whole different beast. The word “whooping” came from the sound that babies make when they’re trying to inhale during the coughing fits of this awful bacterial infection.

Cough-cough-cough-WHOOOOOOOOP (catching breath)

Cough-cough-cough- WHOOOOOOOOP

It starts as a cold, then gets worse in a week or two. It is absolutely heartbreaking to see a baby struggle with whooping cough (watch a Youtube video of “Infant with Whooping Cough” like the one down below, courtesy of the Mayo Clinic and try not to tear up), and it can be deadly to them. They often stop breathing, and almost always must be hospitalized.

Pertussis is easily caught from others via coughed droplets in the air. Older kids and adults can catch it too, and it causes long fits of coughing – to the point of turning blue, or vomiting. Patients cough so much they commonly break ribs.

Antibiotics are given to make the person less contagious, but do not cure the illness or stop the symptoms.

The best protection from whooping cough is VACCINATION. We start this series at age 2 months, so that children are protected as young as possible.

Adults should get their pertussis booster – a.k.a. the Tdap or Tetanus shot at least every 10 years, or with every pregnancy (I and my husband both got it for both our kids).

Hope this helps clarify those confusing words we use for these special cough sounds!

More On This Topic:

• Why Children Like Olivia Need You To Immunize
• Let's Learn About Whooping Cough
• "Croupy" Cough
• 7 Facts About Whooping Cough You Should Know

When parents report a croupy cough, it means different things. Some parents call bad/deep/dry/wet/rattly coughs croupy.

When I think of “croupy cough,” I mean “barky” like a dog or a seal. We are seeing quite a bit of croup this winter so I thought a quick update might be in order.

Age (When will my kid stop barking?)

The disease typically occurs between 6-36 months (can be as young as 3 mo but usually not older than 6 years).

Season (What time of year does my kid bark?)

Infections typically occur in the fall to mid-winter.

Time (When will my kid bark?)

Most ER admissions for croup occur between 10 p.m. - 4 a.m.. Unfortunately, things really can get worse at night.

Pathology (What makes my kid bark?)

Initially, the virus infects the nose and throat and then spreads downward causing swelling in the area just below the vocal cords. When looking with a camera at this area, there is a lot of swelling and redness (inflammation). The vocal cords themselves can also become swollen, causing them not to close as well. This is what can cause children to have a hoarse quality to their voices when they speak. The speed of the air as it travels through this area coupled with the swelling and inflammation causes the noisy breathing and barky cough.

Recurrence (Why does my kid get croup over and over again?)

Research has shown that some children are more prone to croup than others. I think that this has something to do with shape of the area around their vocal cords, consequently putting them more at risk for difficulty breathing and barky cough with any viral infection.

Treatments (What do I do for my little seal?)

All the treatments listed are intended to reduce the swelling in the vocal cords and below, helping your child to be more comfortable.

1. Warm steam – We used to put kids in croup tents where we pumped a humidifier in to get the humidity way up. To achieve the same affect, you can turn on the shower in the bathroom and just sit with the child. You can also run a humidifier in the child’s room.
2. Cold steam – Open the freezer door and put the child’s face in front of the steam the freezer emits.
3. Steroids – Giving the child steroids by mouth (or a shot in severe cases).
4. Racemic epinephrine – This is a specific breathing treatment that currently can only be given in the office or hospital.

Two take home tips:

1. The next time your child is barky, feel free to come in and tell us that your child is “croupy.” However, if your child isn’t sounding like a little seal, it’s helpful to try to find a different word to describe the sound of his or her cough, as there are many different causes for the different sounds of a cough.

2. If I start to explain this process to you in the office, stop me and say, “I got this. I read your blog about it.” Nothing would make me happier.

It hasn't always been easy for us this year. At 4 a.m. or so during Thanksgiving, I heard the telltale "croup cough" coming from my daughter's monitor. It's such a scary sound - that weird bark coming from deep inside your child's chest. They panic, and you panic. They were fine earlier...now this? I took this photo of her at a golf course near our house a mere hours before bed.

The hoarse cry, the worry in her eyes, the sometimes high fever (hers was 102 and making her feel miserable), and a cough that rivals any seal's bellow. And it's always in the middle of the night. Why can't croup make its appearance at lunchtime? 

I remembered the most important thing to do is to keep her calm, and comfortable. The coughing, the gagging, the throat pain - croup is really mean.

I gave her a dose of Motrin, laid down in bed with her (for any of you who know me....you know this is waaay outta the norm for Dr. Diane, Captain Strict of Sleepland), ran my fingers through her curls, and propped her up on me to help her cough. In the morning, we will take a steamy shower with a bunch of toys, and take it easy.

Just a reminder that we are parents, too. We worry just as much as you do, and are losing just as much sleep But as my arm burned up with her fever heat, as my neck grew cramped from laying on 3 unicorns instead of my favorite pillow, I realized she won't always need me like this. In fact, one day, she'll probably kick me out of her room and tell me to leave her alone.

So I bent my pediatrician sleep rules a little bit. Parenting really turns you into a softie, doesn't it? 

Dr. Diane