Kids Health Info

Croup

  • Croup is a viral infection which causes swelling of the voice box (larynx) and windpipe (trachea). This swelling makes the airway narrower, so it is harder to breathe.

    Croup often begins like a normal cold followed by a harsh, barking cough. This may be worse at night when the air is cooler.

    It usually affects children up to five years old. Some children get croup several times.

    Croup can get worse quickly. If your child is having problems breathing they should be seen by a doctor as soon as possible.

    Signs and symptoms

    • Croup often begins like a normal cold, eg a runny nose and cough.
    • Your child's cough will change to become harsh and barking.
    • Your child's voice may be hoarse.
    • They may have a squeaky noise when breathing in, called 'stridor'.
    • The symptoms are often worse at night and reach their worst on the second or third night of the illness.
    • Croup may last for three to four days.

    Treatment by a doctor

    If your child's croup attack is severe they will need to stay in hospital. Severe croup is when your child:

    • Has noisy breathing (stridor) when resting.
    • Muscles around the ribs suck in when breathing.
    • Is very distressed.

    Most children do not need any other specific treatment once they are being closely watched in hospital.

    • Sometimes steroids (prednisolone) taken by mouth are given for croup. The steroids help reduce the swelling in the airway and this will make breathing easier.
    • Antibiotics do not work on viruses and are not given to children with croup.

    Care at home

    A mild attack of croup is when your child has the harsh,  barking cough but does not have noisy breathing (stridor) at rest or is not struggling to breathe.  Mild croup can usually be managed at home with the following treatment:

    • Try to calm your child, as breathing is often more difficult when your child is upset.
    • Keep your child calm by sitting quietly, reading a book or watching a video.
    • If your child has a fever and is irritable you may give paracetamol (eg Panadol, Dymadon, Tempra).
    • Croup often becomes worse at night.  Many children will be more settled if someone stays with them.

    A note about steam

    • In the past, some doctors recommended exposure to mist or steam therapy, including the use of vaporisers.
    • Research evidence now shows this to be of no benefit and it is no longer recommended.

    If your child's croup does not settle and they become more distressed they should be seen by a doctor.

    When to come back

    Your doctor will let you know when to come back for review.

    You should see a doctor or come to an emergency department if:

    • your child's breastbone sucks in when breathing in
    • your child is struggling to breathe
    • your child has stridor (the noise made when breathing in) when at rest
    • you are worried for any other reason

    You should call an ambulance immediately if:

    • Your child looks very sick and becomes pale and drowsy.
    • Your child's lips are blue in colour. 

    Key points to remember

    • There is no specific treatment for croup and it usually gets better in three to four days.
    • Try to calm your child as breathing is often more difficult when your child is upset.
    • Croup can get worse quickly. If your child is having problems breathing they should be seen by a doctor as soon as possible.
    • In a severe attack, your child needs to be watched closely in a hospital.  

    Other sources of information:

    • Your local doctor (GP).
    • Your local hospital emergency or casualty department.
    • The Royal Children's Hospital Emergency Department,
      T: (03) 9345-6153
    • The Royal Children's Hospital Sugar Glider Ward - Level 2,
      T: (03) 9345-5559

     

    Developed in consultation with the RCH departments of General MedicineCentre for Community Child Health and Thoracic Medicine.  First published August 2003. Updated November 2010.


Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.