Croup

About croup

Croup is inflammation and narrowing of the windpipe and vocal cords. This inflammation makes it hard for air to enter the lungs.

Croup is usually caused by a viral infection. The viruses that cause croup are usually the same ones that cause the common cold and influenza.

Croup itself isn’t contagious, but the viruses that cause croup can be spread easily from person to person through coughing, sneezing and hand contact.

Croup is very common in children under the age of five years. It’s more common in autumn and winter.

Croup symptoms and signs

Your child will usually have symptoms of a cold before they get croup symptoms. These symptoms include a runny nose, sore throat, fever and irritability.

Then your child might develop a harsh, barking cough and sometimes a hoarse voice. Your child might also make a high-pitched, squeaky noise as they breathe. This is called stridor.

The noisy breathing and cough are usually worse at night, especially on the second or third night of the illness. Symptoms can also get worse if your child gets upset. In most children, the symptoms improve over 3-4 days then disappear. The cough might linger for up to three weeks.

In some children, croup is more severe and causes breathing difficulties. If your child is having trouble breathing, you might notice the following signs:

The skin (or muscles) around your child’s neck or rib cage suck in as your child breathes.
Your child’s nostrils flare as your child breathes.
Your child has trouble feeding and drinking.
Your child is drooling or has problems swallowing.
Your child is restless and won’t lie down.

Does my child need to see a doctor about croup?

If your child is under six months old and has symptoms of croup, you should take your child to see your GP.

If your child is older and has any of the following symptoms, take your child to see the GP if your child:

is having trouble breathing
has noisy breathing that you can easily hear, even when your child is resting quietly
is sucking their breastbone as they breathe in
has trouble swallowing
is very distressed.

You should always take your child to see the GP if your child’s symptoms are getting worse.

Severe croup requires emergency medical attention. You know your child best, so trust your instincts if your child doesn’t seem well. If your child has significant breathing difficulties, your child’s skin or lips are pale or blue, or your child is drowsy or hard to wake up, call 000 for an ambulance.

Tests for croup

Your GP will diagnose croup after checking your child’s symptoms and examining your child.

Treatment for croup

Mild croup symptoms
Children with mild croup don’t need special treatment. You can manage the symptoms in the same way as you manage cold symptoms.

Start by making sure your child is drinking enough so they don’t get dehydrated, especially if they have a fever. Here’s what to do:

For breastfed babies younger than six months, offer feeds more often.
For formula-fed babies younger than six months, offer the usual amount of formula. Offer smaller but more frequent feeds.
For breastfed babies older than six months, offer feeds more often. You can also offer water between feeds.
For formula-fed babies older than six months, offer the usual amount of formula. Offer smaller but more frequent feeds. You can also offer water between feeds.
For children older than one year, offer water or an oral rehydration fluid like Gastrolyte® or Hydralyte™. You can buy oral rehydration fluid from pharmacies and many supermarkets. You might need to give your child smaller amounts of water or oral rehydration fluid more frequently, especially if they’re really unwell. For example, you might need to offer a few mouthfuls every 15 minutes.

Here are some other things you can do to ease your child’s symptoms:

If your child has a fever and is uncomfortable, give your child paracetamol in the recommended dose and frequency. Or you could give ibuprofen to children aged over three months.
Don’t pressure your child to eat. If your child isn’t hungry while they have a fever, that’s OK. Your child’s appetite will come back as they start to feel better.
Try one teaspoon of honey at night, which might help with coughing. But don’t give honey to children under 12 months because of the risk of botulism.
Try to keep your child calm. Your child might have more trouble breathing if they’re upset, frightened or stressed.

Ask your pharmacist or GP if you aren’t sure about which medications or treatments are best for your child’s croup.

Severe croup symptoms
If your child has severe croup symptoms, your child might need a short course of corticosteroids like oral prednisolone or dexamethasone. This treatment helps to reduce the swelling in your child’s windpipe.

A few children with croup need to go to hospital for observation, to make sure that their windpipes don’t get blocked. While in hospital, your child might initially get adrenaline in the form of inhaled mist. This reduces the swelling in the windpipe very quickly while the corticosteroids work.

Croup prevention

Your child and family can take some simple precautions to prevent the spread of the viruses and bacteria that cause croup and reduce your chances of getting sick.

Here’s how:

Make sure you regularly wash hands with warm, soapy water.
Keep your hands away from your face as much as possible.
Cough or sneeze into a tissue or your elbows.

Because croup can sometimes be caused by the influenza virus, flu immunisation might reduce the chance of your child developing croup. It’s recommended that all children over six months be immunised against flu every year. If you want your child immunised against flu, talk to your GP.

To minimise the spread of the virus that caused your child’s croup, keep your child away from child care, preschool or school while your child is sick. Your child is usually contagious for three days after the illness has started, or until the fever has gone.