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, flu and COVID-19.

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 6 years. It’s more common in autumn and winter.

Croup symptoms and signs

Your child might have symptoms of a cold before they get croup symptoms. Cold 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 3 weeks.

In some children, croup is more severe and causes breathing difficulties. If your child is having breathing difficulties, 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.

Medical help: when to get it for children with croup symptoms

If your child is under 6 months old and has symptoms of croup, 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 lethargic, particularly if they don’t have a fever
is very distressed.

You should always take your child to see the GP if your child’s symptoms are getting worse. If you can’t get an appointment with a GP, take your child to a hospital emergency department.

Severe croup requires emergency medical attention. You know your child best, so trust your instincts if your child doesn’t seem well. Call 000 for an ambulance 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.

Tests for croup

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

Mild croup: treatment

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

The key thing is to make sure your child is drinking enough so they don’t get dehydration.

Babies 0-6 months: tips for avoiding dehydration

If your baby is breastfed, offer feeds more often.
If your baby is formula fed, offer the usual total amount of formula but in smaller, more frequent feeds.

Babies 6-12 months: tips for avoiding dehydration

If your baby is breastfed, offer feeds more often.
If your baby is formula fed, offer the usual total amount of formula but in smaller, more frequent feeds.
Offer water between feeds.

Children 12 months and older: tips for avoiding dehydration

Offer water or an oral rehydration fluid like Gastrolyte or Hydralyte. You can buy these from pharmacies and many supermarkets.
Offer small amounts of water or oral rehydration fluid more frequently, especially if your child is very unwell. For example, offer a few mouthfuls every 15 minutes.

Children of all ages: tips for comfort

If your child has a fever and is uncomfortable, give your child paracetamol in the recommended dose and frequency. Or you can give ibuprofen to children aged over 3 months.
Let your child eat according to their appetite. Your child might not be hungry while they have a fever. Their 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 infant 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 medicines or treatments are best for your child’s croup.

Don’t give aspirin to children under 12 years unless it’s prescribed by a doctor. Aspirin can make children susceptible to Reye’s syndrome. If you’re giving your child any over-the-counter medicines, check with your pharmacist or doctor to make sure these have no aspirin.

Severe croup: treatment

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 your child is in hospital, they might be given 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 simple precautions to prevent the spread of the viruses and bacteria that cause croup and reduce your chances of getting sick:

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.

Croup can sometimes be caused by an influenza virus, so flu immunisation might reduce the chance of your child developing croup. It’s recommended that all children over 6 months be immunised against flu every year.

Croup can also sometimes be caused by the COVID-19 virus, so COVID-19 immunisation might reduce the chance of your child developing croup. It’s recommended that some children from 6 months and all children from 5 years be immunised against COVID-19.

Talk to your GP for more information about getting your child immunised.

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 3 days after the illness has started, or until the fever has gone.