Croup

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Croup is a viral infection of the throat (upper airway). The virus causes swelling of the voice box (larynx) and windpipe (trachea). This swelling makes the airway more narrow, so it is harder to breathe.

Croup often begins like a normal cold followed by a harsh, barking cough, described as "croupy". This often happens at night when the air is cooler.

It usually affects children up to 5 years old. Some children get croup many times. There is no way to prevent croup as it is caused by different viruses. There is no immunisation against croup.

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 e.g. runny nose and cough.
• Then your child will get a harsh, barking, croupy sounding cough.
• Your child’s voice may be hoarse.
• They may have a noise when breathing in, called 'stridor'.
• The symptoms are usually worse at night and reach their worst on the second or third night.
• Croup may last for 3-4 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:

1. Has noisy breathing (stridor) when resting.
2. Muscles around the ribs suck in when breathing.
3. 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 or by nebuliser (a light spray given with oxygen) are given to your child. The steroids help reduce the swelling in the airway.  This makes breathing easier.
• Antibiotics do not work on viruses and are not given for croup.

Care at home

A mild attack of croup is when your child has the 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 and calm your child as breathing is often more difficult when your child is upset.
• Try keeping your child calm by sitting quietly, reading a book or watching a video.
• If your child has a fever and is irritable give paracetamol (e.g. Panadol, Dymadon, Tempra).
• Croup often becomes worse at night, so your child may 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.
• Their lips are blue in colour. 

Key points to remember

• There is no specific treatment for croup and it usually gets better in 3-4 days.
• Try and 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
• Royal Children's Hospital Emergency Department (03) 9345-6153
• Royal Children's Hospital General Medical Ward - 5th Floor (03) 9345-5559

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