Age range for croup and signs to watch

It can occur outside that range, but a very young baby or older child with a barking cough or noisy breathing should be assessed because the clinician may need to consider other causes. Age alone cannot confirm or exclude croup.

Croup is usually a viral illness that causes swelling around the voice box and windpipe. A young child's airway is narrow, so a small amount of swelling can produce a seal-like barking cough, a hoarse voice, and a harsh high-pitched sound when breathing in called stridor.

Symptoms may follow a runny nose, sore throat, or fever and can become more noticeable at night. As the airway grows wider and firmer with age, the same type of infection is less likely to create the characteristic breathing symptoms.

Keep the child upright, calm, and comfortably close to you because distress and crying can make noisy breathing more pronounced. Offer frequent drinks and check breathing regularly, including during the night. A clinician or pharmacist can advise on suitable medicine for fever or discomfort.

Do not use steam inhalation because hot water can cause burns and steam has not been shown to relieve the airway swelling. Avoid cough medicines that cause drowsiness, as sleepiness may hide worsening breathing. Arrange a child health consultation when croup is suspected; a prescribed steroid may reduce airway swelling.

Request an ambulance through 998 when a child is struggling for breath, has blue or grey lips or skin, has pauses in breathing, is unusually sleepy or hard to wake, becomes limp, or cannot speak, drink, or feed because of breathlessness.

Emergency assessment is also needed for drooling with difficulty swallowing, marked pulling-in under the ribs or at the neck, or agitation that cannot be settled. Seek same-day medical advice if stridor is present while the child is calm, breathing is becoming harder, fluid intake is poor, or symptoms are worsening.

Describe when the cough started, whether stridor occurs only during crying or also at rest, how the child is drinking, and whether the chest or neck pulls inward with each breath. Ask whether treatment for airway swelling is needed and what breathing changes mean the child should be reassessed. Mention previous croup episodes and any unusually early or late age at presentation.