Cough with a croup sound: what to know

Croup is an upper-airway illness that can make a child's cough sound barking or seal-like. A high-pitched noise when breathing in is called stridor and suggests narrowing around the voice box and windpipe. Croup often becomes more noticeable at night and may follow cold symptoms. Other airway problems can sound similar, including asthma, bronchiolitis, acute bronchitis or an inhaled object. The sound matters less than the child's breathing effort, colour, alertness and ability to drink. Do not assume every harsh cough is croup, especially if it began suddenly while eating or playing.

Keep the child calm and upright, because crying can make noisy breathing worse. Offer small, frequent drinks if swallowing is comfortable and watch them closely. Do not use steam or put a child over hot water, as burns can occur and steam is not a reliable treatment. Avoid cough medicines unless a clinician or pharmacist specifically recommends one for the child. Note when the sound occurs, whether it is present at rest, and whether the child has fever, drooling or reduced drinking.

Call emergency services if the child is struggling to breathe, the skin pulls in between the ribs, lips look blue or grey, the child is unusually sleepy, cannot speak or cry normally, is drooling and unable to swallow, or the noisy breathing continues while resting. Seek urgent clinical advice for a first episode, rapid worsening, poor fluid intake or signs of dehydration. A clinician may prescribe treatment to reduce airway swelling after examining the child.

Ask whether the sound is stridor, what to monitor overnight, whether prescribed treatment is needed, and exactly when to return or call emergency services.