Croup in Children

Croup is one of the most common respiratory (breathing) infections in young children. Children with croup usually have a very distinctive barking cough and hoarseness.

Most cases of croup are mild, but it can sometimes cause serious breathing problems for babies and small children. Here is all you need to know about croup, its causes and how to manage it when your child is sick.

What is croup?

Croup is a contagious viral infection that causes swelling in the upper airway, including the voice box (larynx) and windpipe (trachea). This infection can make the airway swell and narrow, leading to a unique barking cough, hoarseness and breathing problems.

Croup usually affects children under 3 years old and isn’t seen as often in older children. This is because their windpipes get larger and swelling is less likely to get in the way of their breathing.

What causes croup?

The most common cause of croup is viruses. Croup viruses include parainfluenza, influenza (the flu), respiratory syncytial virus (RSV), measles, adenovirus and SARS-CoV-2 (COVID-19).

These viruses spread easily through the air when someone who is infected coughs or sneezes. Your child can also get croup by touching infected surfaces or objects (i.e., tabletops and toys).

Who is most at risk for croup?

Croup is usually seen in babies and children between 6 months and 3 years. Some things that can increase the chance of getting croup include:

• Time of year: Croup is more common in the fall and winter, but it can happen anytime.
• Other health issues: Children with asthma or a history of croup are more at risk.
• Secondhand and thirdhand smoke: Being around tobacco smoke or pollutants can make croup more likely.

What are the symptoms of croup in a child?

At first, your child may have a stuffy or runny nose, a low fever and a slight cough. These symptoms get worse as the virus moves from the nose to the lungs. 

These signs could be:

• A cough that sounds like a seal or dog barking.
• Hoarseness – your child’s voice could sound odd or scratchy.
• Trouble breathing or hearing a high-pitched sound when they breathe (stridor).

Croup often becomes worse at night and may last several days. However, the cough may stick around for a few weeks. 

How is croup different from RSV and whooping cough (pertussis)?

Croup, RSV and whooping cough are all respiratory illnesses, but their causes, symptoms and treatment are different.

RSV can affect people of all ages but is especially severe in infants and older adults. RSV can cause runny nose and cough and sometimes can cause the barking cough of croup.  RSV often affects the lungs while croup usually only involves the upper airway.   

Whooping cough (Pertussis) is caused by bacteria, not a virus. While it also causes a very particular cough, whooping cough can often make your child throw up after a long coughing spell.  In some babies it can cause them to stop breathing. There are no medicines or vaccines to prevent croup, but the good news is that there is a vaccine to prevent whooping cough, and antibiotics to stop the spread of whooping cough among people known to be exposed to the bacteria.

How is croup diagnosed?

Health care providers can usually tell if your child has croup by listening to their symptoms and doing a physical exam.

They might ask about your child’s symptoms and how long they’ve been going on. They’ll check your child’s breathing, listen for certain sounds and might use a light to look at their throat.

Usually, other tests like X-rays or specific viral swabs aren’t needed.

How is croup treated?

Croup treatment will depend on your child’s age, symptoms and how serious the condition is. If your child has a history of respiratory problems or was born prematurely, that may also affect their treatment.

Mild croup symptoms

Mild symptoms can usually be treated at home. Here are some tips on what you can do to make your child more comfortable as they heal:

• Comfort them: Keep them calm and relaxed and offer plenty of fluids to drink.
• Over-the-counter pain relievers: Children’s strength acetaminophen or ibuprofen can lower fever and ease discomfort. Check with your child’s health care provider for the right dose amount.
  • Do not give ibuprofen to children under 6 months of age. Aspirin should always be avoided. Give medicines only as directed. Ask your child’s provider for help if you have questions. 
• Avoid cough medicines: Let them cough as it helps clear their airways. If your child is over 12 months old, a teaspoon or two of honey can help soothe their throat.
• Sleep position: Prop their head up during sleep to make breathing easier.
• Stay away from smoke: Secondhand and thirdhand smoke from tobacco, fireplaces or fire pits can make croup symptoms worse.
• Cool, moist air: A bedside cool-mist humidifier may help with breathing. In cooler weather, you can also sit with your child outside for a few minutes to get some fresh, cool air.
• Watch their condition: Keep an eye on your child’s symptoms. If things get worse, call their provider.

Moderate symptoms

If your child’s symptoms don’t improve or get worse, call their provider. Some children may need a breathing treatment or steroid medication to calm swelling in the airway.

Severe symptoms

Call 911 or take your child to the closest emergency department if your child:

• Struggles to catch their breath.
• Has noisy breathing when they rest.
• Seems to “pull in” around the chest area near the collarbone and ribs with each breath (retraction).
• Has a hard time swallowing or starts to drool.
• Turns bluish around the lips or face.
• Is unable to speak or cry.
• Becomes very tired or hard to wake up.

In an emergency, Banner Children’s offers 24/7 pediatric emergency services. If your child is struggling to breathe, visit one of our nearby emergency departments for immediate care.

What can I do to prevent croup?

Croup is spread just like the common cold, so it is difficult to prevent.

Keep your child home from school or daycare when they’re ill or if it’s known that an illness is spreading.

Regular hand washing and teaching your child to sneeze and cough into their elbow can help stop the spread of viruses. Also try to get your child to avoid touching their face, especially their nose and mouth.

Make sure your child is up-to-date with all recommended shots. These immunizations can help reduce the risk of some of the infections that can lead to croup.

Our expert specialists

Banner Children’s caring staff is here to help treat, diagnose and guide you through every phase of your child’s life. Not sure if your child needs to see a doctor in person? Banner Children’s offers telehealth services for expert advice from the comfort of your home. Learn more about virtual visits.

Most children with croup recover at home with supportive care. If you're unsure whether your child needs medical attention, our pediatric specialists are here to help. Schedule an appointment with us today.