What should you know about treatment of croup in pediatrics?

Croup is inflammation around the voice box and upper windpipe, often following a viral cold. Children may develop a barking cough, hoarse voice, or a harsh sound when breathing in called stridor. Fever may occur, but breathing effort and the sound at rest are more useful for judging severity than the cough alone. Croup often worsens at night. A child with mild symptoms may be assessed in primary care, while persistent noisy breathing at rest, chest pulling in, or exhaustion needs urgent care. Learn more about [Croup](/conditions/croup/), [Cough](/symptoms/cough/), and the [Common Cold](/conditions/common-cold/).

Keep the child upright and calm because crying can increase airway noise. Offer small sips of fluid if swallowing is comfortable, and follow the clinician's medicine instructions. A corticosteroid may reduce airway swelling; the route and dose depend on the child's assessment. More severe croup may need nebulised medicine and observation, with oxygen or other airway support if breathing becomes difficult. Steam, hot vapour, and cough medicines are not substitutes for assessment and can create hazards. Do not force food or drink when the child is struggling to breathe.

Call emergency services for blue or grey lips, pauses in breathing, severe chest pulling, drooling with difficulty swallowing, unusual sleepiness, or a child who cannot speak or cry normally because of breathlessness. Seek urgent assessment when stridor is present while the child is resting, symptoms are worsening, or the child cannot keep fluids down. Stay with the child, keep them upright, and avoid distress during transfer. A mild barking cough without noisy breathing at rest still deserves medical advice if it returns or the child's condition changes.

Ask how to recognise stridor at rest, how long the prescribed medicine should take to work, and what to do if the cough returns overnight. Ask whether your child needs observation, which fluids are suitable, and when normal activity can resume. If breathing treatment was given, ask what response to expect and which changes require emergency help. A [Child Health Consultation](/treatments/consultations-and-assessment/child-health-consultation/) can provide an age-specific review.