Croup at night: what to do when symptoms flare

A child may wake with a barking cough, hoarseness or noisy breathing after appearing better earlier. Crying and fear can make upper-airway noise more obvious. A common cold can sit behind the episode, but symptoms should not be dismissed simply because they began during sleep. The key distinction is whether noisy breathing happens only during a cough or continues while the child is quiet and resting.

Go to your child promptly, use a calm voice and help them sit upright. Offer a small drink if swallowing is easy. Watch the chest and neck for pulling in, listen for noisy breathing at rest, and check colour and responsiveness. Keep smoke and strong scents away. Do not use steam or give unadvised cough medicine. If a clinician has already supplied a plan, follow it; otherwise seek advice before using a nebuliser or prescription medicine.

Urgent help is needed for hard or rapid breathing, ribs or neck pulling in, stridor while resting, blue or grey lips, drooling or inability to swallow, pauses in breathing, or unusual difficulty waking. Contact a clinician promptly if the episode repeatedly wakes the child, drinking is poor, or the child is deteriorating. Stay nearby while monitoring and take worsening symptoms seriously even if the cough briefly settles.

Ask what to do if symptoms return overnight, which number to call, and whether your child needs a review. Record when the episode started, what the breathing sounded like while resting, whether the child could drink, and any temperature or medicine given.