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The Link Between Croup and COVID-19

Omicron's Impact on Younger Children

pediatrician and infant

Parents, by nature, tend to worry about their little ones, especially when they’re feeling lousy. That’s certainly been the case with COVID. According to the American Academy of Pediatrics, nearly 4.2 million children have had COVID in the U.S. since the beginning of January.

And now, there’s been a recent development that is impacting young children in a new way – a connection between COVID’s omicron variant and croup, a barking-sounding cough that is most common among children between the ages of six months and three years.

Doctors are noticing a correlation between croup and positive COVID cases because it appears omicron tends to settle higher up in the respiratory tract, rather than in the lungs. While croup isn’t typically serious, it can be alarming for parents especially since their young ones aren’t yet eligible for the COVID vaccine.

“What we think the connection is between omicron and croup is that omicron has been a little different than other COVID strains," says Dr. Asma Khan, a pediatrician for OSF HealthCare.  "The other COVID strains were hitting our lower respiratory – we were having more lung issues and it hit the lower respiratory tract. Omicron is hitting more of the upper respiratory tract – our nose, our pharynx, our larynx, which is our voice box, so it’s presenting more like a common cold. And with little children, because of the inflammation, it can cause more of this croup-like cough.”

Croup is an infection of the upper airway, which hampers breathing and causes the barking cough. The cough and other symptoms of croup are the result of swelling around the voice box, windpipe and bronchial tubes. In addition to the cough, taking a breath often sounds like a high-pitched whistling sound called stridor. Croup cases are most common in the fall and winter months.

“There was a study done at Seattle’s Children (Hospital), which looked at patients that came into the ER with croup – they looked at about 500 kids," says Dr. Khan. "They were simultaneously testing every child that came in with croup-like illness for COVID, and they found that about 100 of these kids were actually COVID positive. When they looked at the percentage they noticed that only about 2 to 3 percent of the croup-like cases that were secondary to COVID occurred with the Delta strain, but 48 percent with the omicron strain.”

In addition to the barking-like cough, other symptoms of croup are fever, hoarse voice and labored breathing. Symptoms typically last between 3 to 5 days. Humidifiers can help ease symptoms, but if the coughing or inflammation gets worse. Dr. Khan says steroids might be required or even a trip to the emergency department. 

“If you have mild symptoms it’s important to still get checked out to assess the severity," says Dr. Khan. "If it’s getting more serious, at least the provider can determine how bad it is and if it requires more treatment than just supportive care. They can pick up on that during the visit and appropriately take care of it before it gets really bad.”

The best thing for young children is to not get COVID in the first place. Dr. Khan recommends anyone who is old enough to get vaccinated. That’s the message she conveys to parents.

“I think the vaccine helps with severity, helps prevent spread, and it does prevent complications in the pediatric world," she says, "so I talk about how important it is for everyone to be vaccinated.”

For more information on croup, visit OSF HealthCare.



Interview Clips 

View Dr. Khan, COVID link
Dr. Khan, COVID link
View Dr. Khan, Seattle study
Dr. Khan, Seattle study
View Dr. Khan, get checked out
Dr. Khan, get checked out
View Dr. Khan, get vaccinated
Dr. Khan, get vaccinated