When is nebuliser treatment recommended for croup?

Croup affects the voice box and upper windpipe, producing a barking cough and a harsh sound when breathing in. A nebulised medicine can be used in an urgent-care setting to reduce airway swelling while the child is observed. The treatment choice depends on the sound at rest, breathing effort, alertness and response to initial care. Mild croup may be managed without a nebuliser after assessment.

Keep the child calm and upright, because crying can make the noisy breathing more pronounced. Offer sips of fluid if swallowing is comfortable. Avoid steam, smoke and unprescribed cough medicines. A healthcare professional may give steroid treatment and, for more marked symptoms, a nebulised medicine. See [Croup](/conditions/croup/) and [Nebuliser Treatment](/treatments/acute-and-urgent-care/nebuliser-treatment/) for related information.

Get urgent help if noisy breathing continues while the child is calm and resting, the skin pulls in around the ribs or neck, the child drools or cannot swallow, becomes very sleepy, or the lips look blue or grey. Call emergency services if breathing is severely difficult or the child cannot speak, cry or drink normally.

Ask how severe the croup appears, whether treatment should be given now, how long observation is needed, what to do if the cough returns overnight, and which changes mean immediate emergency care.