Croup in infants treatment: what parents should know

Croup is swelling around the voice box and upper windpipe, often after a viral illness such as a common cold. It can cause a harsh, barking cough and a noisy sound when the infant breathes in. Crying may make the sound louder because agitation increases the work of breathing. An infant may have a hoarse voice, runny nose, or fever, although symptoms vary. A clinician listens to breathing and watches the chest, colour, alertness, and ability to drink; tests are not always needed.

Keep the infant calm and upright in your arms, and offer breast milk or fluids in small amounts if swallowing is comfortable. Avoid smoke, strong scents, and forcing the child to lie flat. A clinician may prescribe medicine to reduce airway swelling. If breathing becomes more difficult, supervised nebuliser treatment or observation may be needed. Do not give cough medicines, leftover antibiotics, or steam treatments unless a clinician specifically advises them. Monitor breathing while the infant is awake and asleep, and arrange a child health consultation for an assessment.

Seek emergency help immediately if the infant has noisy breathing while resting, pulling in at the ribs or neck, blue or grey lips, pauses in breathing, marked sleepiness, drooling with difficulty swallowing, or cannot drink. Contact a clinician promptly if the barking cough is worsening, fever persists, wet nappies decrease, or you are unsure how hard the infant is working to breathe. Keep the infant upright during transport and take any prescribed medicines with you.

Ask which signs mean the infant needs emergency care, whether a steroid or nebuliser treatment is appropriate, how to offer fluids, and what to do if symptoms return at night.