What should you know about noisy breathing with croup?

Croup is usually a viral upper-airway illness. Swelling near the larynx can produce a harsh, high-pitched sound called stridor, often more noticeable when a child breathes in. A barking cough, hoarse voice, runny nose, or fever may occur. Stridor only during crying is different from stridor while calm; the latter suggests greater narrowing and deserves urgent clinical assessment.

Keep the child calm and upright, because crying can make the sound and breathing effort worse. Offer small sips of fluid if they can swallow comfortably. Watch the colour of the lips and skin, breathing rate and effort, alertness, and ability to drink. Do not use steam or give cough medicines unless a clinician advises it. A child health consultation can assess severity; treatment may include prescribed medicine, and selected cases may need nebuliser treatment.

Seek emergency help if noisy breathing is present while the child is resting, the ribs or neck pull in, the child struggles to speak or drink, becomes unusually sleepy, drools, develops blue or grey lips, or breathing pauses. Do not make the child lie flat or force food and drink while they are struggling. If the sound is new or worsening, obtain same-day medical advice.

Is the noise stridor, wheezing, or congestion? Is it present when my child is calm? What signs should make us return urgently? Which medicines are suitable, and how should we monitor breathing overnight?