Severe croup symptoms: what to know

Croup is usually triggered by a viral infection and causes swelling around the voice box and windpipe. A harsh, barking cough and a hoarse voice are typical. Stridor is a high-pitched sound when breathing in; hearing it while your child is calm is more concerning than hearing it only after crying. Severe illness may include fast or laboured breathing, pulling in of the skin between or below the ribs, difficulty speaking or drinking, unusual sleepiness, or pale, blue, or grey lips. Fever can occur, but the breathing pattern matters most.

Keep your child upright and as calm as you can, because crying can worsen airway noise. Stay with them, loosen tight clothing, and offer small sips if swallowing is comfortable. Do not force food or drink, put anything in the throat, or rely on steam. A clinician may assess oxygen levels and breathing and may prescribe medicine to reduce airway swelling; urgent services may use nebuliser treatment when appropriate. Arrange a child health consultation for new or worsening symptoms, even if the cough later settles.

Call emergency services immediately if stridor continues at rest, breathing is severely laboured, the child cannot speak or drink, drooling prevents swallowing, or they become floppy, confused, very drowsy, or develop blue or grey lips. Seek urgent same-day assessment for repeated noisy breathing, worsening chest retractions, dehydration, or a child who is getting rapidly worse. Do not drive alone if the child is struggling to breathe.

Ask what breathing signs should trigger emergency help, whether medicine is needed for the current episode, how to give it, and what follow-up is appropriate if symptoms return overnight.