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Croup

Advice for professionals

Croup is a common childhood illness that causes a bark like cough. It can also cause difficulty breathing which can be frightening for both you and your child.

Croup is caused by a virus which affects the airways including the voice box (larynx), windpipe (trachea) and lungs (the bronchi) causing them to swell and become narrower. 

Some children have croup two or more times in their childhood.

Related topics: bronchiolitis, cough and colds, difficulty breathing

Paediatric Pathway

To see the croup paediatric pathway click here.

When should you worry?

If your child has any of the following:

  • Breathing very fast, too breathless to talk, eat or drink

  • Working hard to breathe, drawing in of the muscles below the ribs 

  • Breathing that stops or pauses

  • A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)

  • Drooling more than normal and struggling to swallow their own spit

  • Is pale, blue, mottled and/or unusually cold to touch

  • Difficult to wake up, very sleepy or confused

  • Weak, high-pitched, continuous cry or can’t be settled

  • Has a fit (seizure)

  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red or amber features)

  • Has a rash that does not go away with pressure (the ‘Glass Test’)

You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Breathing a bit faster than normal or working a bit harder to breathe

  • A harsh noise as they breathe in (stridor) only when upset

  • Dry skin, lips or tongue

  • Not had a wee or wet nappy in last 8 hours

  • Poor feeding in babies (less than half of their usual amount)

  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)

  • Is 3-6 months old with temperature 39oC or above (unless fever in the 48 hours following vaccinations and no other red or amber features)

  • Temperature of 38oC or above for more than 5 days or shivering with fever (rigors)

  • Temperature less than 36°C in those over 3 months

  • Getting worse and I am still worried

You need to contact a doctor or nurse today

Please ring your GP surgery or call NHS 111 - dial 111

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features

If your child has none of the above:

  • Watch them closely for any change and look out for any red or amber symptoms

  • Additional advice is also available for families for help cope with crying in otherwise well babies

  • If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

This content has been developed by healthcare professionals from across the UK in collaboration with the RCPCH.

What are the symptoms of croup?

  • A cough. The cough is usually harsh and barking. This ‘croupy cough’ is due to inflammation and swelling of the vocal cords in the voice box (larynx).

  • Noisy breathing. The infection can narrow the voice box (larynx) and windpipe (trachea) and cause an extra noise called a stridor. This noise is normally heard on breathing in.

  • Breathing may become difficult if the narrowing becomes worse.

  • Your child may also have a runny nose, hoarse voice, sore throat, high temperature (fever), general aches and pains and be off their food. Croup may follow a cold but can also appear without any earlier illness. 

  • The symptoms of croup appear worse at night. A mild but irritating cough may persist for a further week or so.

How can I help my child?

  • Stay calm. This will help keep your child calm. Children with croup may become upset. Crying may make their symptoms worse.

  • Sit your child upright on your lap if their breathing is noisy or difficult. Let them find the most comfortable position.

  • Encourage your child to drink cool drinks regularly (little and often) to help soothe their throat and keep them hydrated.

  • If your child seems to be in pain or discomfort, you can give your child Paracetamol or Ibuprofen, following the instructions on the container.

  • If their temperature is high, dress them in cool, loose clothes (if any) and don’t use anything warmer than a sheet to cover them in bed.

  • Stay with your child or check him or her regularly. You need to know if the symptoms are getting worse.

  • Some people find that taking their child outside in the cool, fresh air helps to relieve their symptoms

  • There is no evidence that steam inhalation helps. There is a risk of scalds if steam is used.

  • Do not give cough syrup. It is not recommended for children under 6 years. It can make children sleepy and does not help croup.

How is croup treated:

  • Your child may be given a steroid medicine called dexamethasone or prednisolone which can reduce airway swelling

  • As croup is caused by a viral illness antibiotics are not needed.

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