What should you know about hoarse barking cough?

A harsh, seal-like cough with a hoarse voice often comes from irritation or narrowing near the voice box. It may occur with a viral cold, particularly in children, and can sound worse at night. Other causes of cough include [Acute Bronchitis](/conditions/acute-bronchitis/), allergies, asthma, reflux and less common airway conditions.

Listen for noisy breathing when resting, a pulling-in of the skin between the ribs, or a child who is unusually quiet or tired. The sound is useful information, but it cannot establish the cause without considering age, breathing effort and the wider illness.

Keep the person calm and upright, because crying can make noisy breathing worse. Offer small sips of fluid if swallowing is comfortable. Avoid smoke and do not use steam that could burn the skin. A clinician or pharmacist can advise whether any medicine is suitable; do not give cough medicines to a young child unless advised.

Arrange same-day medical advice when the cough is new in a young child, is worsening, or comes with fever or reduced drinking. Mention whether the cough began suddenly, followed choking, or is worse at night. Possible related conditions include [Croup-like airway swelling](/conditions/common-cold/) and [Bronchiolitis](/conditions/bronchiolitis/).

Call emergency services for blue or grey lips, severe difficulty breathing, pauses in breathing, inability to speak or cry normally, drooling with difficulty swallowing, or extreme sleepiness. Seek urgent assessment for noisy breathing while resting, chest indrawing, or a child who cannot drink. Keep the person upright and follow the emergency operator’s instructions.

Ask: Is the noisy breathing coming from the upper airway? What should we watch during sleep? Which medicine, if any, is appropriate? How much fluid is enough? When should we return or call emergency services?