Croup vs. Epiglottitis in Children: What First Responders and Parents Need to Know

/ Delta Emergency Support Training /

When a child has trouble breathing, both parents and first responders feel the urgency. Two conditions often confused with one another are croup and epiglottitis. While both affect the airway, they differ dramatically in severity and required response. For parents, understanding the warning signs can help you know when to call for help. For first responders, recognizing the difference is critical to providing safe and effective care.

Croup: Common but Often Alarming

What it is:
Croup is a viral infection that causes swelling of the larynx and trachea, most often seen in children aged 6 months to 3 years.

Parents may notice:

  • Barking, seal-like cough (especially at night)

  • Hoarse voice

  • Stridor (high-pitched sound on inspiration) when crying or upset

  • Low-grade fever

  • Symptoms often start after a cold

First responder perspective:

  • Most cases are mild, but moderate to severe croup can cause stridor at rest, increased work of breathing (retractions, nasal flaring), or fatigue.

  • Treatment may include humidified oxygen, steroids (e.g., dexamethasone), and nebulized epinephrine in severe cases.

  • Keeping the child calm is key; agitation worsens obstruction.

Epiglottitis: A True Airway Emergency

What it is:
Epiglottitis is a bacterial infection that causes the epiglottis to swell rapidly, threatening complete airway obstruction. Thanks to Hib vaccination, it’s now rare, but still life-threatening when it occurs.

Parents may notice:

  • Sudden onset of high fever

  • Severe sore throat and difficulty swallowing

  • Drooling (child can’t swallow saliva)

  • Muffled voice

  • Child sitting forward, chin out, mouth open (“tripod position”)

  • Appearing very ill, anxious, and struggling to breathe

First responder perspective:

  • This is a do not delay, do not agitate situation.

  • Never attempt to look in the child’s throat — it can trigger complete obstruction.

  • Keep the child upright and calm.

  • Provide high-flow oxygen if tolerated.

  • Be prepared for advanced airway intervention (hospital setting or with ALS backup).

  • Rapid transport is essential.

Quick Comparison

FeatureCroup (Viral)Epiglottitis (Bacterial, Emergency)OnsetGradual, after cold symptomsSudden, rapid progressionCoughBarking, seal-likeRare or absentFeverLow-gradeHighVoiceHoarseMuffled, “hot potato” voiceSwallowingUsually ablePainful, droolingStridorCommon, louder when upsetLate, quieter, concerningSeverityUsually mild-moderateSevere, life-threatening

The Takeaway

For parents:

  • Croup is common and usually manageable, but if your child has stridor at rest, difficulty breathing, or bluish lips, call 911.

  • Epiglottitis is rare but an emergency — if you see drooling, high fever, tripod posture, or sudden severe breathing trouble, call for help immediately.

For first responders:

  • Stay calm and keep the child calm.

  • Differentiate based on history and presentation.

  • Supportive care is often enough for croup, while epiglottitis requires immediate rapid transport and careful airway management.

When it comes to pediatric airway conditions, the rule is simple: if in doubt, treat it like epiglottitis until proven otherwise. Quick recognition and action save lives.