Croup in children: symptoms and treatment

Croup is a childhood viral illness that causes swelling around the voice box and windpipe.

The narrowed upper airway creates the characteristic barking cough and can make breathing noisy. Croup is most often seen in younger children because their airways are smaller, so even modest swelling can change the sound of breathing.

A barking cough is a very common presentation of croup. Children may have a hoarse voice, a runny nose, fever and a high-pitched noise when breathing in, called stridor. Symptoms are often more noticeable at night and can vary through the day.

Call emergency services if your child is struggling to breathe, has stridor while resting, seems unusually sleepy or distressed, has blue or grey lips or face, is drooling and cannot swallow, or becomes floppy. Do not delay because of the possible cause.

Viruses that cause cold-like illnesses can trigger croup, including viruses associated with the common cold. Infection spreads through respiratory droplets and contaminated hands or surfaces. Croup is not caused by cold air, although cool air may sometimes seem to ease discomfort briefly.

Croup often begins with cold symptoms before the cough and voice changes develop. The airway swelling usually settles as the viral illness improves, but symptoms can intensify quickly during the night. Check your child regularly and reassess if breathing changes.

Younger children may have more noticeable breathing sounds because of the size of their airways. A child with previous airway problems, chronic lung disease, or difficulty managing fluids should be assessed with a lower threshold when croup symptoms appear.

Clinicians usually diagnose croup from the cough, breathing sound and examination. They look for the work needed to breathe, alertness, colour and hydration. Tests are not usually needed when the presentation is typical, but other causes of noisy breathing must be considered when signs are unusual or severe.

Keep your child calm and upright, offer fluids in small frequent amounts, and use fever or pain medicine only as advised for their age and health. Steam is not recommended because hot water can cause burns and it does not treat airway swelling.

A clinician may prescribe a steroid medicine to reduce airway swelling. More severe croup can require observation and inhaled treatment, such as nebuliser treatment, in an urgent-care setting. Do not try to examine a distressed child’s throat at home.

Stay with your child when symptoms are active and keep an eye on breathing during sleep. Encourage quiet activities and fluids. If the cough sounds worse but your child is comfortable and breathing easily, contact a clinician for guidance; if breathing effort increases, seek urgent help.

Handwashing, cleaning frequently touched surfaces and avoiding close contact when someone is unwell can reduce spread of respiratory viruses. Keep children home from nursery or school when they are clearly unwell and follow local advice about returning.

A child health consultation can assess a barking cough, fever or noisy breathing and explain the care plan. Use emergency care immediately for breathing difficulty, stridor at rest, colour change, drooling or a child who is hard to rouse.