Croup vs. COVID-19: How to Tell the Difference

Now let’s break down the differences between croup and COVID-19 and what you can expect from each illness.

Croup

Croup is most often caused by a viral infection. Parainfluenza viruses are the most common cause of croup, but influenza viruses, adenoviruses, enteroviruses, and the respiratory syncytial virus (RSV) can cause it as well.

The first symptoms of croup are very similar to those of other upper respiratory infections, such as the common cold. They include:

• fever
• runny nose
• sore throat

In the next day or so, the characteristic “barking” cough appears. Some children may develop stridor, a harsh sound that’s made when they breathe in. Stridor can also happen with rapid, shallow breathing and nostril flaring. These symptoms are often worse at night.

It’s possible for croup to happen without cold-like symptoms. This is called spasmodic croup and is also commonly caused by viruses. Children with spasmodic croup often have croup symptoms that recur periodically.

COVID-19

The novel coronavirus, SARS-CoV-2, causes the viral infection COVID-19. Generally speaking, fewer instances of COVID-19 have been observed in children compared with adults.

Many of the symptoms of COVID-19 in children are similar to those in adults and can include:

• fever
• fatigue
• cough
• body aches and pains
• headache
• sore throat
• shortness of breath
• runny or stuffy nose
• loss of smell or taste
• abdominal pain
• digestive symptoms like diarrhea, nausea, or vomiting
• loss of appetite or poor feeding

A 2020 review of 10 studies that described 2,914 children with COVID-19 found that the most commonly reported symptoms were cough, fever, and sore throat.

As in adults, children who have contracted SARS-CoV-2 may not have symptoms. The Centers for Disease Control and Prevention (CDC) notes that as many as half of children who contract the novel coronavirus may be asymptomatic.

Recently, there have been reports of children presenting to the hospital with symptoms of croup testing positive for COVID-19. These include:

• a January 2021 report of a 14-month-old boy with symptoms such as fever, cough, and stridor
• a March 2021 report of a 3-year-old boy with symptoms such as cough, stridor, and hoarseness
• a May 2021 report of three children, ages 11 months, 2 years, and 9 years, with barking cough, stridor, and respiratory distress

There’s overlap between the symptoms of croup and the common COVID-19 symptoms in children. Because of this, you may be curious about how you can tell if your child’s symptoms are due to COVID-19 or another cause of croup.

Some things you can consider are:

• Time of year. COVID-19 has been reported year-round, while croup mostly occurs in the fall and winter months.
• Other symptoms. While symptoms can vary by individual, COVID-19 has many more potential symptoms than croup. Some to look out for include headache, digestive symptoms, and loss of taste and smell.
• Known COVID-19 exposure. If your child has recently been in contact with someone who has confirmed COVID-19, they may also have contracted the virus.

The only way to be sure whether your child has COVID-19 is to have them get a COVID-19 test. To do this, you can reach out to your child’s doctor or seek out a COVID-19 testing site in your area.

Croup is most often treated at home with supportive care. This includes things like:

• resting
• getting plenty of fluids
• taking over-the-counter medications to help ease symptoms like fever and discomfort
• keeping children comfortable, as distress may make symptoms worse

Your child’s doctor may prescribe a medication called dexamethasone to help treat croup. This is a steroid medication that reduces inflammation, helping to open the airways.

When croup is severe, treatment in a hospital may be necessary. Both dexamethasone and nebulized epinephrine are given. If a child is dehydrated, they may also receive intravenous (IV) fluids.

If croup symptoms are caused by COVID-19, supportive care will also be used. Most cases of mild or moderate COVID-19 in both children and adults can be treated at home.

According to the CDC, the Food and Drug Administration (FDA) hasn’t yet approved any drugs to treat COVID-19 in children. However, the following treatments may be used for children with severe COVID-19:

• supplemental oxygen
• remdesivir, an antiviral drug
• dexamethasone

The chart below can help you compare the potential symptoms of croup with COVID-19 and other common childhood illnesses.

As you can see, many of these illnesses have a significant overlap in symptoms. If you ever have questions or concerns about symptoms that your child is experiencing, don’t hesitate to speak with their doctor.

There’s also some overlap in the serious symptoms of both croup and COVID-19. It’s important to seek prompt medical attention or call 911 if you notice any of the following symptoms:

• stridor
• difficulty breathing
• rapid breathing
• retractions, where the skin sucks in around the ribs when a child breathes in
• increasing levels of distress or agitation
• decreased alertness
• skin, lips, or fingernails that appear blue in color
• high fever
• inability to drink fluids or keep fluids down

If you suspect that your child has COVID-19, be sure to let staff know when you arrive at the doctor’s office or hospital.

Croup is a common respiratory infection in children. Its symptoms include a barking cough, fever, and sore throat. Some children may also have stridor when they breathe in.

Three of the most common COVID-19 symptoms in children are fever, cough, and sore throat. In some cases, COVID-19 can present with symptoms of croup. The only way to be sure what’s causing a child’s symptoms is a COVID-19 test.

Most children with either croup or COVID-19 can recover at home. However, it’s important to seek emergency medical attention for symptoms like stridor, difficulty breathing, and decreased alertness.