Croup and a child's age

Croup is swelling around the voice box and windpipe, usually during a viral illness. It typically presents with a harsh barking cough, hoarse voice and a high-pitched sound when breathing in, called stridor. A small amount of swelling has a greater effect in a narrow young airway. Older children have wider airways, so the same swelling may cause less obstruction. In a very young baby, or when symptoms are unusual for the child's age, a clinician may consider other causes of noisy breathing.

Keep the child calm and upright because distress can make noisy breathing more noticeable. Offer frequent drinks in amounts they can manage, check that they are passing urine, and use age-appropriate fever relief only as directed. Avoid steam, which can burn and has no reliable role in opening the airway. Check the child during the night and listen for stridor while they are resting, not only while crying. A clinician may prescribe medicine that reduces airway swelling; use it exactly as instructed.

Seek urgent medical help if stridor is present while the child is calm, the skin pulls in around the ribs or neck, breathing looks tiring, or the lips appear blue-grey. Drooling with difficulty swallowing, marked drowsiness, agitation that cannot be settled, or being too breathless to drink are also emergency signs. Keep the child upright and calm while help is arranged. A barking cough without breathing difficulty can often be assessed less urgently, but rapid worsening should prompt immediate reassessment.

Describe whether noisy breathing happens at rest, whether the child can drink, and how alert they are. Ask how long the prescribed medicine should take to help, which changes require another assessment, and whether the child's age or repeated episodes suggest another diagnosis. Mention any sudden onset after choking because an inhaled object requires a different response.