What should you know about croup without a cough?

Croup commonly produces a barking cough because the upper airway is swollen, but symptoms can vary and a cough may not be heard during a short observation. Noisy breathing, a hoarse voice or increased effort can still need attention. Other explanations for cough or breathing sounds include a common cold, asthma, bronchiolitis, allergic rhinitis, acid reflux or acute bronchitis. Longer-lasting cough may have a different cause, including chronic cough or bronchiectasis. These possibilities cannot be sorted safely from one symptom alone.

Keep the child calm and upright, and observe breathing while resting. Note whether there is stridor, wheezing, hoarseness, fever, choking, vomiting or exposure to an irritant. Offer fluids if swallowing is comfortable. Do not give another person’s inhaler or cough medicine. Arrange a clinical assessment if the sound is new, persistent or unexplained, taking a recording only if doing so does not delay care.

Get emergency help for severe effort, blue or grey lips, pauses, sudden choking, inability to swallow, collapse or unusual drowsiness. Seek prompt assessment for noisy breathing while calm, chest pulling in, worsening symptoms, poor drinking or a child who cannot speak or cry normally. The absence of a barking cough does not make breathing difficulty safe.

Ask whether the sound is stridor, wheezing or something else; whether the upper airway needs examination; and which symptoms should trigger emergency help. Describe onset, triggers, sleep symptoms, fever, feeding and any choking or allergy history.