What should you know about croup and stridor?

Croup causes swelling in the upper airway, so air moving in can produce a harsh sound called stridor. It often becomes louder when a child cries, coughs or becomes frightened. A barking cough and hoarse voice commonly accompany it. Stridor can also have other causes, including an inhaled object or a different upper-airway problem, so the sound should not be diagnosed from a recording alone.

A cough or fever may occur with the infection behind croup, but they do not show how narrow the airway is. Breathing effort, skin colour, alertness and the ability to drink are more important warning signs.

Keep the child upright, quiet and close to a familiar caregiver. Offer small sips if swallowing is comfortable. Do not force the child to lie down, inspect the throat with objects, or use hot steam. Follow a clinician’s plan for prescribed medicine. A child health consultation can assess whether stridor is present and whether treatment is needed; nebuliser treatment may be used in a monitored clinical setting for selected cases.

Seek urgent medical care if stridor is heard at rest, the ribs or neck pull in, the child cannot speak or cry normally, drools, struggles to swallow, becomes unusually sleepy, or develops blue or grey lips. Call emergency services for severe breathing difficulty, pauses in breathing or reduced responsiveness. Do not wait for a barking cough or fever before seeking help.

Ask whether the sound is stridor or wheeze, whether it occurs at rest, and what treatment was given or prescribed. Ask how to position the child, which changes need emergency care, and when a follow-up assessment is needed.