Croup without a fever: what parents should know

Croup is swelling around the voice box and upper airway, commonly after a viral illness. A barking cough, hoarse voice, or harsh sound when breathing in can appear with or without fever. The absence of fever does not confirm or rule out croup, and a cough alone can have several causes, including a common cold.

Notice whether noisy breathing happens only during crying or also while the child is calm. Also check whether the child can drink, speak or cry normally, and remain responsive.

Keep the child calm and upright, because distress and crying can make upper-airway noise more pronounced. Offer frequent sips of fluid and avoid smoke or strong scents. Do not use steam from boiling water, leftover prescription medicine, or cough medicines unless a clinician has advised it for this child.

Arrange a child health consultation if the diagnosis is uncertain, symptoms are recurring, or the cough is interfering with sleep or drinking. A clinician may decide whether an airway-opening treatment, including nebuliser treatment, is appropriate.

Seek emergency help if the child struggles to breathe, has persistent noisy breathing while resting, pulls in the skin between or below the ribs, becomes unusually sleepy, cannot swallow fluids, drools, or develops blue, grey, or very pale lips. Keep the child upright while help is arranged.

Prompt medical assessment is also needed if symptoms are worsening, the child is drinking much less, or you are unsure whether the sound is coming from the upper airway. Fever is only one observation; breathing effort and alertness carry greater urgency.

Ask: Does this sound like croup or another cause of cough? What breathing changes should prompt immediate help? Does my child need medicine or nebuliser treatment, and how should it be used? How can we maintain fluids overnight?