Bad croup: what should you know?

Croup often follows a viral illness such as a common cold. The cough may sound harsh or barking, and the voice can become hoarse. A high-pitched noise when breathing in is called stridor. Symptoms may become more noticeable at night or when a child cries, because distress increases the work of breathing.

Croup severity depends on breathing effort, alertness, colour, and the sound at rest, not on the cough alone. Fever may occur, but its absence does not rule croup in or out.

Keep the child calm and upright on your lap, offer small sips of fluid if swallowing is comfortable, and monitor breathing closely. Avoid forcing food, using hot steam, or giving medicines that were not advised for that child. A clinician may recommend treatment such as a steroid; severe airway swelling may require nebuliser treatment and observation.

Call emergency services if the child is struggling to breathe, has ribs pulling in, becomes unusually sleepy, cannot swallow saliva, develops blue or grey lips, or has stridor while resting. Seek prompt assessment when noisy breathing is new, worsening, or not settling after the child is calm. Do not wait for fever before acting.

How severe is the airway noise, and does my child need treatment today? What breathing changes should I watch at home? When should we return, and could a child health consultation help with follow-up?