Croup

Croup is a childhood condition that affects the windpipe (trachea), the airways to the lungs (the bronchi) and the voice box (larynx).

Croup usually affects young children aged between 6 months and 3 years, though they could be younger or older. Most cases happen in 1 year olds. It’s more common during the late autumn and early winter months. It tends to affect more boys than girls. A child can have croup more than once.

Croup in adults is rare.

Symptoms of croup

Children with croup have a barking cough that sounds like a seal. They’ll make a harsh sound, known as stridor, when they breathe in. Stridor is often most noticeable when the child cries or coughs. They may also have a hoarse voice and find it difficult to breathe because their airway is blocked.

Some children have cold-like symptoms for a few days before developing croup symptoms. Croup symptoms usually only last for a few days and are often worse at night. But they can occasionally last up to 2 weeks.

When to get medical advice

Phone 999 or go to A&E if:

Your child:

has severe breathing difficulties
has an increased breathing rate (you can look at their tummy muscles and the effort they use for breathing)
is too breathless to feed or talk or cannot drink fluids
has a pulling in at their throat area (‘tracheal tug’)
finds it difficult to lie down and sleep
has a worsening cough or rasping sound
shows distress and agitation
has dark, blue-tinged or pale skin
the skin around their ribs and chest appears to be pulled in and tight, making the bones of their chest and ribs more visible
has abnormal drowsiness and sleepiness

Speak to your GP practice if:

Your child:

is less than 3 months old and has a temperature of 38°C or above
is aged 3 months or older and has a temperature of 39°C or above
your child has a distinctive barking cough
your child makes a harsh sound when they breathe in

If your GP is closed, phone 111.

Diagnosing croup

Croup can usually be diagnosed by a GP. They’ll check your child’s symptoms, particularly the sound of their cough. If you can, record the noise your child is making on your phone so your GP can hear it. This can be helpful if your child only coughs at night.

Your GP may also:

check your child’s temperature
ask whether your child has recently had a cold or viral infection
do a pulse oximetry test to check your child’s oxygen levels (this involves clipping a sensor onto your child’s earlobe or finger – it does not hurt)
rule out other conditions with more tests

Your GP will decide whether your child needs to go to hospital or whether their croup is safe to treat at home.

You should not try to check your child’s throat yourself. It could trigger a spasm (sudden narrowing) of the airway. This could make breathing even more difficult.

Treatment for croup

Most cases of croup are mild and can be treated at home.

Sitting your child upright and comforting them if they are distressed is important. This is because crying may make symptoms worse. Your child should also drink plenty of fluids to prevent dehydration.

Usually, your child will be prescribed medication to help reduce the swelling in their throat. The medication is a single dose of an oral corticosteroid called dexamethasone or prednisolone. Side effects of these medications can include restlessness, vomiting, upset stomach and headache.

Steam treatment is not recommended.

You should seek urgent medical advice if you notice your child’s symptoms getting worse.

Pain relief for children

Children’s paracetamol can ease pain and may help lower your child’s temperature if they have a fever.

Children under 16 years of age should not be given aspirin.

Speak to your pharmacist or GP if you are unsure about what type of pain relief is right for your child.

Do not use cough medicines or decongestants. These do not help ease the symptoms of croup. These treatments often have drowsy side effects, which can be dangerous when a child has breathing difficulties.

Hospital treatment

In severe cases of croup, treatment in hospital may be needed. This might include your child being given adrenaline or oxygen.

What causes croup?

Commonly, croup is caused by a virus. Several viruses can cause croup but in most cases it is the parainfluenza virus.

The virus can be passed on by close contact with infected people, as well as contaminated objects and surfaces. It’s often spread by breathing in droplets from infected coughs or sneezes.

Other viruses can also cause croup. These include:

influenza A and B (flu viruses)
the measles virus, in children who have not been immunised against measles
the rhinovirus (common cold virus)
enteroviruses
the respiratory syncytial virus (RSV), which can cause severe breathing problems and pneumonia in babies

Less common causes of croup include:

breathing in a small object such as a peanut or a pen cap (inhaled foreign body)
inflammation of the epiglottis (the flap at the base of the tongue that keeps food from going into the windpipe)
a severe allergic reaction (anaphylaxis), for example to certain foods
breathing in irritants such as chemicals
acid leaking back out of the stomach and into the throat (acid reflux)