What Is Croup and How To Treat It As Omicron COVID Variant Linked to the Cough

Doctors in some parts of the country have linked the Omicron COVID-19 variant, which now accounts for the vast majority of cases in the United States, to a condition affecting children under five years of age known as croup.

Dr. Saif Al Qatarneh, a pediatric pulmonologist at West Virginia University, told NBC News that he had noticed an increase in croup diagnoses, as well as an infection of the respiratory tract called bronchiolitis, alongside a rise in pediatric COVID cases.

Dr. Buddy Creech, a pediatric infectious disease expert and director of the Vanderbilt Vaccine Research Program at the Vanderbilt University Medical Center in Nashville, Tennessee, also told NBC that he and his colleagues have observed "croup-like presentations" in young children who test positive for COVID-19.

Croup refers to an infection of the upper airway which obstructs breathing and causes a characteristic barking cough. According to the Mayo Clinic, it is usually caused by a viral infection, most often a parainfluenza virus. But now it appears that the Omicron COVID variant is also causing a number of cases.

Croup is the result of swelling around the voice box, windpipe and bronchial tubes. When a child coughs through this narrowed passageway, the swollen vocal cords produce a coughing noise that sounds almost like a seal or dog barking. In addition, taking a breath often produces a high-pitched whistling sound.

Doctors said the recent croup cases in children with COVID-19 could be occurring because Omicron seems to settle higher in the respiratory tract, compared to other variants that affect areas deeper in the lungs.

"Little kids' airways are so narrow that it takes far less inflammation to clog them," Creech told NBC.

Dr. Peily Soong, from Children's Hospital of Alabama, said he was seeing significantly more positive COVID cases, with the majority of patients under the age of two presenting with croup-like symptoms.

"Toddlers have this raspy and barky cough that we're not seeing with the other variants," Soong told CBS 42. "We're also seeing something called bronchiolitis, it is a respiratory illness that causes some kids to have wheezy symptoms and raspy cough."

Aside from the distinctive barking cough, the symptoms of croup may include fever, a hoarse voice and breathing that may be noisy or labored. Symptoms are typically worse at night and tend to last for three to five days. Fortunately, croup usually isn't serious and most cases are mild.

Dr. Amy Edwards, a pediatric infectious disease expert at University Hospitals Rainbow Babies & Children's Hospital in Cleveland, told NBC: "As pediatricians, seeing more kids with croup and bronchiolitis is oddly reassuring because we've been dealing with those conditions for our entire careers."

Croup can be "scary to hear, but it doesn't mean there is any problem with the lungs," she said. "The main treatment is to keep the upper airways open and clear until the inflammation subsides."

Croup usually goes away on its own, but in some cases a few days of steroids may be required. Only a very small number of children require hospitalization as a result of croup.

While the vast majority of children with COVID-19 will likely only have a mild illness or be asymptomatic, some may develop serious complications that require hospitalization. In fact, Centers for Disease Control and Prevention data shows that COVID hospitalization rates have increased among children aged under five—who are not eligible for vaccination—although admissions are still relatively low.

A sick child with fever
Stock image showing a sick child with a fever. Doctors have noticed an uptick in cases of croup among very young children in some parts of the United States. iStock