What is croup?

Croup is an inflammation of the voice box (larynx) and windpipe (trachea).  The inflammation means the lining swells and mucus production increases, causing a blockage in the windpipe. It usually occurs in babies and toddlers, but can occur in children up to six years. As the children grow, the windpipe strengthens, lessening their susceptibility to croup.

Croup is usually caused by a viral infection. It is usually worst in the first few days and can last up to a week, though the cough can last beyond this time. As the child gets better the cough will usually become looser.

Some children can have a form of croup which comes on quickly, often at night, but also resolves after about an hour or so. These children may be more likely to already have asthma, or to develop asthma.

What are the symptoms of croup?

Croup generally starts like a common cold. Your child may have a slight fever, red eyes, sore throat and runny nose, and not be interested in eating. After several days a hoarse, barking cough and noisy breathing develops. It may be difficult for your child to breathe in. Crying generally makes the barking cough and noisy breathing worse. The symptoms of croup are almost always worse at night.

How can I help my child?

Children with croup should see their doctor. Also contact your doctor if at any time you are concerned about your child's croup, or are worried about his/her breathing, or if you feel his/her condition is getting worse.

As croup is caused by a virus rather than bacteria, no antibiotics are given unless the child develops a bacterial infection as well. Paracetamol can be used to bring down any fever (or check with your pharmacist or doctor for more information about medications for reducing fever in children). 

If the croup is severe, your child may be given medicine from the doctor or hospital, eg. steroid medication or nebulised adrenaline, to reduce swelling in the airways and make breathing easier.

Try to ensure the child has adequate fluid intake and is kept calm and comfortable. Children are often more comfortable in the upright position. Sit toddlers and small children up with pillows. Babies may rest more comfortably in their car seat or stroller in the upright position.

Previously, steam was thought to be useful in treating croup, but this is no longer regarded as a suitable treatment, nor is there any real evidence to prove it is effective. It is also seen as dangerous for the child because of the possibility of burns or scalding. Therefore do not use steam for your child's croup.

Croup can be frightening for the parent and the child. Stay with your child all the time when they are coughing. Handle him or her smoothly, and talk quietly and firmly. The symptoms of croup will be worse if the child is upset and feels that you are not in control.

Warning signs

Occasionally croup can cause serious problems in children.

Take the child to your doctor immediately if he/she:

• starts dribbling or cannot swallow
• cannot bend his or her neck forward
• is not having enough fluid
• makes a high pitched noise or grunt when breathing in
• has a high temperature
• develops earache
• is having difficulty breathing
• or you are concerned that your child is getting worse.

Call an ambulance 111 for emergency medical help if:

• your child has blue or dusky coloured lips (may occur after a coughing spell)
• your child is not breathing continuously
• your child seems delirious.

For further information and support talk to your doctor or practice nurse.

Written and reviewed by everybody, August 2006.