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Your toddler just woke up at 11 pm with a barking, raspy cough. Cue the immediate worry—could it be Covid?

The characteristic croup cough typically strikes at night and can mean difficulty breathing and little sleep for all involved. And while croup is a common sign of an upper respiratory tract infection in young children, new research suggests that croup may now also be a symptom of the Omicron variant that’s specific to kids. 

Study shows link between croup and Covid

In a new peer-reviewed pre-print, a research team at Boston Children’s Hospital examined data on kids treated at the hospital for both Covid and croup from the start of the pandemic. They found that 75 children were diagnosed with Covid-associated croup, and 81% of those cases occurred during the Omicron surge. All children tested positive for Covid; just one child tested positive for a second virus. 

Though the study is relatively small and focused on just one hospital (and therefore somewhat limited in scope), the authors note that the data collected present “compelling evidence” that Omicron causes croup. 

They also state that croup cases linked to Omicron may be more severe than when caused by other non-Covid viruses.

While more research is needed, these findings are in line with what pediatricians across the country have been seeing: a rise in croup cases since the start of the Omicron surge, even in older children. 

What is croup?

Croup isn’t a virus in itself—it’s a condition caused by a virus. In babies and toddlers, when an upper respiratory infection sets in, resulting inflammation may cause a narrowing of the airways (which are already small in young kids), leading to a barky, raspy cough. Croup is rare in older children and adults, but it can still happen.

Why is croup now cropping up more often?

“While early variants typically resulted in lower respiratory infections, the recently identified Omicron variant may exhibit a predilection for the upper airways,” note the researchers. “The relatively smaller upper respiratory tract in children compared to adults has been thought to predispose them to more severe clinical presentations resembling laryngotracheobronchitis, or croup.”

Symptoms of croup

Croup commonly sets in and gets worse at night. Keep an eye out for these signs:

  • Barking cough
  • Raspy or hoarse voice
  • Harsh, audible breathing, known as stridor

Croup may also be accompanied by other cold symptoms, like fever, runny nose and sore throat. 

Most croup cases caused by viruses other than Covid tend to resolve on their own within a week. But if symptoms persist, call your child’s pediatrician. Seek immediate medical attention if you’re worried about their breathing. In some severe cases, steroids may be prescribed to help open up the airways. 

Read more: Is it the flu, a cold, allergies or COVID-19?

Symptoms of Omicron in kids

According to pediatrician Neela Sethi Young, MD, who practices in California and is the co-founder of Jaanuu, the most commonly reported symptoms of Omicron, in order of occurrence, include:

  • Sore or scratchy throat
  • Nasal congestion
  • Dry cough
  • Body aches, most notably back pain and neck pain
  • Mild fever 

“Omicron symptoms usually start with a sore throat and turn to runny nose and coughing with some body soreness,” Dr. Young explains. She notes that the fevers among her patients have been more mild in this wave of the virus, and very few patients are reporting a loss of taste and smell or shortness of breath. In contrast to the Delta variant, Dr. Young notes, “Omicron seems very flu-like.” 

Read more: What are the symptoms of Omicron in kids?

Due to the overlap between the symptoms, the only way to know for sure if your child has Covid is to take a test. It's worth noting that PCR tests are the most reliable, and should be available at your pediatrician’s office or a local testing site.