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What is croup?

Croup is an infection of the larynx (voice box) and trachea (windpipe). The usual cause of croup is a viral infection. Several viruses can cause croup.

Who gets croup?

Croup occurs most commonly between the ages of one to three years and is uncommon after the age of six years. An infection by a similar virus in an older child or adult may cause a cough or sore throat, but is unlikely to cause the breathing symptoms of croup (described below).

Croup often occurs in epidemics in the winter. Some children have two or more bouts of croup in their childhood.

What are the symptoms of croup?

  • Cough, usually harsh and ‘barking’.
  • Breathing symptoms. The infection causes inflammation on the inside lining of the breathing tube. There may also be a lot of thick mucus. A combination of these can cause narrowing of the breathing tube and may cause noisy breathing (stridor). Breathing may become difficult if the narrowing becomes worse.
  • Other symptoms that may occur include a runny nose, hoarseness, and sore throat. Other cold or ‘flu type’ symptoms may also occur, for example fever, being off food, and general aches.

Croup symptoms are often worse at night. Symptoms usually peak after one to three days, and then improve. A mild but irritating cough may last a further week or so.

How serious is croup?

Symptoms are often fairly mild, but sometimes become severe. Many children just get a croupy cough with some cold symptoms. Parents can expect to have one or two disturbed nights nursing a coughing child. Most children with croup remain at home and soon recover.

The main concern is if severe narrowing of the breathing tube develops. If this occurs then breathing can become difficult.

Other treatments:

  • A steroid medicine such as dexamethasone or prednisolone is sometimes prescribed. Steroid medicines help to reduce inflammation. A single dose often eases symptoms within a few hours. Steroid medicines do not shorten the length of the illness but they are likely to improve the breathing symptoms.
  • DO NOT give cough medicines that contain ingredients that can make a child drowsy. This will not help a child who may need extra effort to breathe. There is no evidence that cough medicines and decongestants help in croup.
  • Antibiotics are NOT usually prescribed as croup is normally caused by a virus. Antibiotics do not kill viruses.

Care at home

  • Be calming and reassuring. A small child may become distressed with croup. Crying can make things worse. Sit the child upright on your lap if their breathing is noisy or difficult. Let the child find a comfortable position.
  • Lower the fever (high temperature) if your child is unwell or distressed.
  • Consider giving paracetamol liquid or ibuprofen (please read the instructions on the bottle first). Lightly dress the child if the room is not cold.
  • Give the child lots of cool drinks (if they are happy to take them).
  • Cool air – some people find that it is helpful to have a stroll outdoors, carrying the child upright in the cool fresh air.
  • Steam is now NOT recommended. There is little evidence that this does any good and some children have been scalded.
  • DO NOT make a child with breathing difficulty lie down or drink fluids if they don’t want to, as that could make breathing worse.

Call your GP 

  • Breathing symptoms get worse. Signs that breathing is getting worse include: rapid breathing, needing more effort to breathe, you may see the chest or neck muscles being pulled in with each breath.
  • Frequently barking cough and easily audible noisy breathing (stridor).
  • The child becomes restless or agitated.
  • The child looks unusually pale.

Dial 999 for an ambulance if

Your child is:

  • blue (cyanosed)
  • unusually sleepy
  • struggling to breathe
  • drooling and unable to swallow

Services

Printing of this document is only valid on the day printed, please refer to the website for most up to date information:

https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/croup-children

Service information

Page last updated: 11 March 2024

Review due: 31 March 2025