Pediatric Chest Imaging

Question: My 15 month old was diagnosed with the croup and he was in the hospital for three days under a tent with a humidifier. I felt like they should have done a x-ray to see if he had pneumonia. Do you think he should have got a chest xray?

Answer: Thank you for contacting our Pediatric Imaging Ask an Expert forum. It is very scary when your young child is sick with a respiratory infection. “Croup” is the common name for laryngotracheobronchitis. It is most often a viral infection (meaning that antibiotics won’t help the child get well) that starts out like a common cold, and is characterized by a barking cough that often happens at night or when the child is upset or crying. The child can have difficulty breathing due to swelling in the upper respiratory tract. You can help a child with croup by keeping him calm, giving him frequent small amounts of fluid to drink, and helping him to keep his nose clear. Humidifying the room can sometimes help. Most children have had croup by the time they are 2, and the fact that their airways are shorter makes it harder on them. However, most children recover nicely in about 3 days to 1 week. Medicines such as corticosteriods or inhaled epinephrine can be used in children whose symptoms are severe. Pneumonia is a RARE secondary infection. Xrays are not very useful in diagnosing croup, and are usually only done if the symptoms are not the usual ones. Children are not usually hospitalized for croup, except when they are younger than 6 months, struggling to breathing, or are hard to wake up. I assume your child has now recovered from his bout with croup, so in hindsight, your child’s doctor did him a favor by not giving him an xray that wasn’t needed. Be aware that having croup once does not give your child immunity like some other childhood illnesses. Speak to your child’s doctor at the next regular office visit about what you can do to try to keep it from becoming severe enough to be hospital.