Croup: symptoms and treatments
What is croup?
Croup is an inflammation of the voice box (larynx) and the windpipe (trachea), in which the airway becomes swollen and partially blocked with mucus. This blockage results in the partial collapse of the airway when a child breathes in (rather like a bent straw) leading to breathing difficulties and a characteristic harsh barking cough.
It is usually an illness of very young children, generally those younger than 3 years of age. It is not as common in older children because, as a child grows up, the size and strength of the windpipe increases. Young children, whose windpipes are small and soft, are the most susceptible.
What causes croup?
Croup is usually caused by a viral infection.
What are the symptoms of croup?
Croup generally starts like a common cold. Your child may have a slight fever, sore throat and runny nose. After a few days (often beginning at night) a hoarse, barking cough, a hoarse voice and noisy breathing develop. This can last for a couple of hours then stop, only to return again for the next few nights.
Your child may find it hard to breathe, especially breathing in. He or she may find this upsetting and cry. Crying and being upset generally make the barking cough and noisy breathing worse.
Episodes of croup mostly happen at night when the air is cooler, and usually settle within a couple of hours. The attacks are usually worse in the first few days of the illness.
Treating croup
If your child has croup, it’s important you take him or her to your doctor for assessment. Your doctor may prescribe a steroid suspension or inhaled steroids, even if the croup is mild, because this can prevent the symptoms from getting worse. These medicines are usually very effective, but in more urgent situations children with croup need to be admitted to hospital.
In severe cases of croup, where the situation may be life-threatening, you should dial 000 so that your child can receive emergency treatment, such as the administration of nebulised adrenaline.
How you can help your child
You can help your child to cope in the following ways.
- Sit your child up either in your arms or on soft pillows, and give them reassurance. Croup can be frightening for your child, and children who are upset need comfort and understanding. Sitting your child upright and with their head held high and chin forward (rather than their chin sinking onto the chest) can help open up their airway.
- Give him or her something to drink to help with the sore throat.
- Paracetamol can be given if your child’s sore throat is painful, or if there is a fever.
- Hot moist air is said to help children with croup by loosening the secretions. However, opinions differ on this topic and there is no evidence that breathing humidified air is beneficial. Also, the risk to your child of burns from steam or hot water is a real one, so this treatment is not currently recommended by doctors. If you do try this you could sit in the bathroom holding your child, with the hot tap or shower running, but you must not let your child near the water or steam or let go of them in the bathroom.
As croup is caused by a virus rather than bacteria, doctors don’t prescribe antibiotics for croup.
When to get medical help urgently
Croup is often only a mild illness, but it can become serious quickly.
Get medical help immediately if you notice any of the following:
- your child has difficulty breathing;
- the effort of breathing is tiring your child;
- your child has a high temperature and starts dribbling;
- your child cannot swallow;
- your child becomes pale or blue (which usually happens after a coughing spell);
- you notice your child’s breastbone being sucked right back;
- your child becomes restless, irritable and/or delirious; or
- you are worried or concerned for any reason.
Make sure that you have the phone number of an after-hours doctor service at hand. In severe cases, where breathing difficulties may be life-threatening, dial 000 for emergency treatment.
Last Reviewed: 23 June 2009
- 1. MayoClinic.com. Croup [updated 2008, Aug 5; accessed 2009, Jun 4]. Available at: http://www.mayoclinic.com/health/croup/DS00312
2. Therapeutic Guidelines (eTG). Croup. In: Respiratory, Antibiotic and Emergency Guidelines [updated 2008, Feb; amended 2009, Mar; accessed 2009, Jun 4]. Available from: http://www.tg.org.au/
3. Johnson D. Croup. BMJ Clinical Evidence 2009;03:321
