Croup: Know the Symptoms & Treatments

The barking cough is the hallmark symptom of croup. Learn the treatments.

What is croup?

Croup (known medically as acute laryngotracheobronchitis) is caused by several common viral infections that cause the upper airways to swell. Its hallmark symptom is a barky cough. Most often, younger children (6 months to 3 years old) develop croup because their airways are so small.

Generally, croup is not serious and can be treated at home. It gets better on its own within a few days. Though in more severe cases, the airways become so narrow that a baby or child has trouble breathing and develops high-pitched noisy breathing (called stridor). When this happens, go to the emergency room or call 911.

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Common symptoms of croup

Dr. Rx

Croupy coughs (sounds like a barking dog or seal) and stridor (a high-pitched sound) tend to recur 3 nights in a row. Often the exam the next day is normal. Usually, a description and an exam is enough to make the diagnosis. Only rarely might an x-ray be done. —Dr. Heather Finlay-Morreale

Children with croup often start with general cold symptoms—fever, cough, congestion, or runny nose. As symptoms worsen and the airway becomes more swollen, a baby or child may develop a barking seal-like cough, a hoarse voice, and high-pitched breathing.

Sometimes, instead of being gradual, croup may occur suddenly at night and recur every night for several days.

Main symptoms

  • Barking cough, often described as sounding like a seal/dog
  • Hoarseness
  • Stridor: noisy breathing or a high-pitched sound like a whistle (most commonly when breathing in)
  • Fever
  • Congestion
  • Runny nose
  • Sore throat

Other symptoms requiring urgent medical attention

Croup can be dangerous if a child has trouble breathing because their airways have become so narrow. Look for faster breathing, working harder to breathe, flared nostrils, the belly moving more than usual with breaths, or the skin sucking in around the ribs and breastbone. If these develop, call your pediatrician or go to the ER.

This video shows a young child in respiratory distress due to croup.

Call 911 if your baby or child has:

  • Respiratory distress: fast breathing, belly breathing, sucking in around the ribs and breastbone, nostrils flaring.
  • Drooling when sitting (and it’s hard for them to lie down, face-up).
  • Has blue lips/fingers.
  • Fatigue.
  • Pallor (very pale).
  • Dehydration.
  • Is unconscious.

What makes croup more likely?

  • Being 6 months to 3 years old.
  • Fall and early winter: Viral illnesses that most commonly cause croup tend to peak during these times.

What is croup caused by?

A number of common viruses can infect the lining of the nasal passages and the upper airway, causing them to become inflamed and swollen. Smaller areas of the airway, such as the vocal cords (larynx) and windpipe (trachea) become narrowed. This leads to hoarseness, noisy breathing, and difficulty breathing.

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How do you treat croup at home?

Pro Tip

It’s scary when in the middle of the night your child is having trouble breathing. But croup is easily treatable with steroids, so call your doctor or go to the ER. —Dr. Finlay-Morreale

Contact your pediatrician if your child has symptoms of croup. For mild cases, your child can be treated at home, similar to how you would treat a cold.

  • Follow your pediatrician’s advice. Generally, you can give acetaminophen (Tylenol) for fever and achiness. If your child is older than 6 months, you can also try ibuprofen (Motrin). Never give aspirin to a child.
  • To help with the breathing, sit with them in a steamy bathroom—run a hot shower with the bathroom door closed.
  • Alternatively, cool air from a cold night may help. Open the window near a child, or open the freezer and let the child breathe the cold air.
  • For babies or toddlers in diapers, make sure they are not dehydrated by keeping track of wet diapers. A baby should have at least one wet diaper every 6 hours. Encourage plenty of fluids. For infants, offer formula or breastmilk or Pedialyte. For toddlers, offer plenty of fluids (like water, juice, Pedialyte, popsicles, etc.). Other signs of dehydration are dry lips, sunken eyes, and dark urine.

Your doctor may prescribe steroids such as dexamethasone. This reduces swelling in their airway.

If your child has a severe case of croup and goes to the ER, they may need to be given nebulized epinephrine (at the hospital). Nebulized epinephrine reduces swelling in the airways. They may also need supplemental oxygen if they have decreased oxygen levels or difficulty breathing.

Follow up

If discharged from the hospital or ER, your child should be seen by their pediatrician within 24 to 48 hours after discharge, to make sure the respiratory distress hasn’t returned. When steroids wear off in 36 to 48 hours, some children may need a second dose. If your child received nebulized epinephrine and the stridor returns, they will be readmitted to the hospital.

Croup usually goes away in 3 to 4 days. If symptoms worsen or continue for longer, check in with your child’s pediatrician.

Pro Tip

Sometimes children improve in the car on the way to the ER—cold air helps. Have someone take a video of what was happening at home to show the doctor. —Dr. Finlay-Morreale

Prevention

Inflammation of the airway can also be caused by certain types of bacteria that can lead to difficulty breathing and serious life-threatening illnesses. Vaccines keep kids from getting these infections. General cold-prevention strategies are the most effective:

  • Wash your child’s hands often with soap and water, especially whenever you come home from being outside. Family members should also do this!
  • Avoid contact with sick people.
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