Croup and rapid breathing: what should you know?

Croup causes swelling around the voice box and upper windpipe. A child may breathe faster when crying, frightened, feverish, or trying to move air through a narrowed passage. The more concerning pattern is fast or effortful breathing that remains present after the child is comforted. Listen for a harsh high-pitched sound when breathing in, called stridor. Notice whether the skin pulls between the ribs, above the breastbone, or at the neck. These observations tell a clinician more than the cough sound alone.

Keep the child upright and calm; crying can increase airway turbulence and make breathing look worse. Offer small sips if swallowing is comfortable, and avoid forcing food or drink. Count the breathing pattern while the child is settled, and note whether noisy breathing occurs at rest. Do not put anything into the mouth or use sedating medicines unless prescribed. Contact a clinician promptly for advice. Medical treatment may include assessment and, when appropriate, inhaled medicine delivered by a nebuliser.

Call emergency services if breathing is severely laboured, the child cannot speak or cry normally, lips look blue or grey, the child becomes floppy or difficult to wake, or there is drooling with trouble swallowing. Urgent assessment is also needed for stridor at rest, pauses in breathing, or rapidly worsening effort. Do not wait for a cough or fever to become more severe before seeking help.

Ask how to distinguish fast breathing from breathing effort, which signs mean emergency care, and whether the child needs review after treatment. Ask what information to record if symptoms return during sleep.