What should you know about RSV croup cough?

Respiratory syncytial virus can cause cold symptoms and swelling around the voice box and upper windpipe. That narrowing can make a cough sound bark-like, especially at night. A child may also have a runny nose, hoarse voice, fever, or noisy breathing. RSV may affect smaller airways too, so watch the whole breathing pattern rather than the cough sound alone. Croup-like symptoms can occur with other viruses, and a cough does not identify the cause by itself.

Keep the child calm and upright, because crying can make noisy breathing worse. Offer frequent small drinks and allow rest. Check on them regularly, including during sleep, and avoid smoke or strong fragrances. Do not use leftover antibiotics or cough medicines unless a clinician has advised them for this child. A clinician may listen to the chest and upper airway and decide whether treatment is needed. Related causes of cough include [Common Cold](/conditions/common-cold/) and [Bronchiolitis](/conditions/bronchiolitis/).

Seek emergency help if the child is struggling to breathe, the skin between or below the ribs is pulling in, lips look blue or grey, breathing pauses occur, or the child is unusually difficult to wake. Urgent assessment is also needed for drooling with trouble swallowing, a very quiet or weak voice, or noisy breathing while resting. Contact a clinician promptly if symptoms are worsening, drinking is poor, or urine is much less frequent.

Ask whether the breathing noise is coming from the upper airway or chest, what signs should prompt emergency care, and how often to check breathing overnight. Tell the clinician when the cough began, whether it is worse at rest, and how much the child is drinking.