Croup

Croup

Croup is a viral illness in young tamariki (children) which causes narrowing of the upper airways. Croup is often a mild illness but can quickly become serious, so don't hesitate to get medical help.

What's croup and what should I do if my child gets croup?

KidsHealth video. Find out what croup is and what to do if your child gets croup.
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Key points about croup

  • croup is a viral illness in young tamariki
  • croup causes narrowing of the upper airways
  • croup symtpms are often worse at night or when your child is upset
  • croup is often a mild illness but can quickly become serious
  • if you are worried, see a health professional

What is croup?

Croup is a viral illness in young tamariki, which causes narrowing of the upper airways. Some tamariki have recurring croup and this may need further assessment.

Illustration of the changes in the airway with croup in an infant

How does croup develop?

When you breathe, air passes through the voice box (larynx) and windpipe (trachea) into the lungs. In croup, a viral infection causes inflammation and swelling of the lining of the voice box and windpipe, which become narrowed. When the airway becomes narrowed, breathing in becomes more difficult, and you can hear stridor (a harsh noise when breathing in).

Who gets croup?

Toddlers are most likely to get croup.

Toddlers are most likely to get croup. Their windpipes are softer than those of older tamariki. When the airways become inflamed, they narrow and this causes stridor. If your child gets croup and is less than 6 months of age, or of school age, see a health professional.

What are the signs and symptoms of croup?

Tamariki with croup have:

  • a barking cough
  • a type of noisy breathing called stridor 

Stridor may only last for a few days. The cough may last for up to a week or so. Your child's voice is usually hoarse. Breathing becomes more difficult and the stridor gets worse when your child becomes upset.

The symptoms of croup seem to often appear or get worse at night. Before the cough and breathing trouble develop, your child may have other symptoms such as:

  • a sore throat
  • a temperature
  • red eyes
  • a runny nose, or
  • a poor appetite

Check out the signs that your child is struggling to breathe

What is the treatment for croup?

Viruses cause croup, so antibiotics don't help.

Mild croup

If your child has a mild case of croup, then you can manage it at home without medicine.

Moderate to severe croup

In moderate to severe croup, doctors may prescribe steroid medicine. This reduces the swelling in your child's airway and helps them to breathe more easily. It doesn't change the cough but does reduce the stridor (the harsh noise heard when your child breathes in). Steroids work for about 48 hours.

In the most severe cases, your child may need to have nebulised adrenaline in hospital.

How can I care for my child with croup at home?

Calming and comforting your child

If you are caring for your child with mild croup at home and they become upset, try to calm and comfort your child on your lap. Distress can worsen the breathing difficulty and stridor.

Helping with a sore throat or fever

Cool sips of fluid may be soothing if your child's throat is sore.

You can give paracetamol if your child is miserable with a fever or has a sore throat. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.

Go to a health professional if croup gets worse

If their croup gets worse and you are worried that it might be serious, take your child to a health professional, the nearest accident and emergency clinic or the nearest hospital emergency department for help

Don't use steam

Although adding steam to the air (humidification) used to be recommended, there is no evidence it actually helps. There have been several cases reported where tamariki have been badly burned from the hot water. For these reasons, health professionals do not recommend using steam for croup.

How long does croup last?

Croup is usually at its worst in the first few days of the illness.

Generally, croup is at its worst in the first few days of the illness. Stridor may only last for a few days while the cough may last for up to a week or so.

When should I seek help for my child with croup?

When do I need to see a health professional urgently?

If your child has any of the following, go to a doctor or the nearest hospital straight away:

  • there is stridor (a harsh noise heard when breathing in) when your child is calm and not upset
  • you are worried your child is having increasing difficulty with their breathing
  • your child becomes upset and you can't calm them
  • your child has other signs of sickness (such as pale colour, a very high temperature, cool or clammy hands and feet, or dribbling)
  • you are worried for any other reason

Check out the signs that your child is struggling to breathe

When should I dial 111?

Dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for urgent medical help if your child has any of the following:

  • becomes blue
  • becomes pale or blue after a coughing spell
  • has extreme difficulty breathing
  • there is a change in their behaviour (for example, they become drowsy, agitated or delirious)
  • has pauses in breathing

Could there be another reason for my child's croup-like symptoms?

In pēpi (babies) less than 6 months of age, or in tamariki older than 6 years, croup is less common. There could be another reason for their symptoms. Make sure to take your child to a health professional for a check up. Your child might need to see a paediatrician (a specialist in children's health) or ENT (ear, nose and throat) specialist.

What happens if my child gets croup again?

It is very uncommon for tamariki to have more than one episode of croup a year for their first 2 or 3 years. See a health professional and ask for a review of your child's symptoms if they have continuing symptoms of either:

  • stridor
  • barking cough (that is, several episodes each year, or episodes that continue into school age)

Your child may need to see a paediatrician (specialist in children's health) or ENT (ear, nose and throat) specialist.

Acknowledgements

Croup illustration by Dr Greta File. Property of KidsHealth. 

Starship Foundation and the Paediatric Society of New Zealand acknowledge the cooperation of the Starship Respiratory Service at Starship Children's Health in making this content available to patients and families.

This page last reviewed 07 December 2021.

Call Healthline on 0800 611 116 any time of the day or night for free health advice when you need it