Croup in Children
Croup is a common infection in children. It causes swelling in the
upper part of the airway in the neck. It causes a barking cough, with or without fever.
And it may cause problems with breathing. The illness is seen more often in the
A virus is the most common cause of croup. But the illness may also be caused by
bacteria, allergies, or reflux from the stomach. Viruses that are known to cause croup
- Parainfluenza virus
- Respiratory syncytial virus (RSV)
- The flu (influenza virus)
Croup is spread through direct
contact with an infected person or their body fluids. The infection starts in the
and throat and moves into the lungs. Swelling affects the area around the voice box
(larynx) and into the windpipe (trachea).
Younger children are more affected by croup because their airways are
smaller. A small amount of swelling can make it very hard for a baby or young child
breathe. Croup is most often seen in children 3 months to 5 years old. The peak time
croup to occur is 2 years old.
The symptoms of croup are not always the same. As the illness moves from the nose
the lungs, the symptoms can change. They may include:
- A runny or stuffy nose and slight
- A cough that turns into a “seal’s bark”
- Losing their voice (laryngitis) or
having a hoarse cry
- A high-pitched “creaking” or whistling sound when breathing in (stridor)
These symptoms are often worse at night and may wake your child from sleep. They may
also seem to get better in the morning but get worse as the day goes on. Most children
feel better in 3 to 7 days.
The symptoms of croup can be
mistaken for other health problems. Make sure your child sees their healthcare provider
for a diagnosis.
Your child’s healthcare provider
can diagnose croup with a health history and physical exam. Your child may need tests
the provider thinks they may have other illnesses. A neck and/or chest X-ray may be
Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is.
In severe cases of croup, or if
your child is not breathing well, your child may need to go to the hospital. You can
manage most milder cases at home. But it can sometimes be hard to tell if your child
needs to go to the hospital because the illness changes. Your child may seem better
moment and then get worse the next. Your child’s healthcare provider may order the
following medicines to help ease symptoms:
Inhaled medicines. These are used if your child is having
a lot of trouble breathing. Inhaled treatments may be used to ease the whistling
sound (stridor) and make it easier to breathe.
Steroids. An injectable steroid is often given if the
child can’t take steroids by mouth (oral). This medicine can help prevent the illness
from getting worse.
Other medicines. Your child's healthcare provider may
prescribe other medicines if they feel your child’s croup is from allergies or
reflux. The provider may also recommend acetaminophen or ibuprofen for a fever or
discomfort. Antibiotics are not useful if the illness is caused by a virus.
For a milder case, these methods may help at home:
- Have your child rest and drink plenty
- Don’t smoke in the home. Smoke can
make your child’s cough worse.
- Keep your child’s head raised. Prop an
older child up in bed with extra pillows. Never use pillows with babies younger than
- Sleep in the same room as your child
to help your child right away if they start to have trouble breathing.
- Stay calm. If your child sees that you
are frightened, it will increase their anxiety and trouble breathing.
- Comfort your child. Sing your child’s
favorite bedtime song or offer a favorite toy.
Breathing in steam or cool night
air may also help your child breathe easier. You may want to try:
- Putting a humidifier in your child’s
- Putting a warm, wet washcloth over
your child’s nose and mouth as they breathe
- Creating a steam room in your bathroom. Turn on the hot water in your bathroom
shower. Keep the door closed so the room gets steamy. Sit with your child in the steam
for 15 to 20 minutes. Don't leave your child alone.
- If your child wakes up at night, try
bundling them up and going outside to breathe in the cool night air.
Here are tips to prevent the spread
- Wash your hands often. Teach your
child how to correctly wash their hands.
- Stop your child from sharing cups and other dishware.
- Keep your child at home until they are
When to Call a Healthcare Provider
911 right away if your child:
- Makes a whistling sound (stridor) that
becomes louder with each breath
- Has stridor when resting
- Has a hard time swallowing their
saliva, or drools
- Has increased trouble breathing
- Has a blue or dusky color around the
fingernails, mouth, or nose
- Struggles to catch their breath
- Can't speak or make sounds
Call your child's healthcare provider right away if your child:
- Has a fever (see Fever and children,
- Has a cough or other symptoms that
don't get better or that get worse
- Doesn't get better within a week
- Has a fever that goes down but they still “act sick”
- Has a seizure
Fever and children
Use a digital thermometer to check your child’s temperature. Don’t
use a mercury thermometer. There are different kinds and uses of digital
thermometers. They include:
Rectal. For children younger than 3 years, a rectal
temperature is the most accurate.
Forehead (temporal). This works for children age 3 months
and older. If a child under 3 months old has signs of illness, this can be used
for a first pass. The provider may want to confirm with a rectal
Ear (tympanic). Ear temperatures are accurate after 6
months of age, but not before.
Armpit (axillary). This is the least reliable but may be
used for a first pass to check a child of any age with signs of illness. The
provider may want to confirm with a rectal temperature.
Mouth (oral). Don’t use a thermometer in your child’s mouth
until he or she is at least 4 years old.
Use the rectal thermometer with care. Follow the product maker’s
directions for correct use. Insert it gently. Label it and make sure it’s not used
the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal
thermometer, ask the healthcare provider what type to use instead. When you talk with
any healthcare provider about your child’s fever, tell him or her which type you
Below are guidelines to know if your young child has a fever. Your
child’s healthcare provider may give you different numbers for your child. Follow
your provider’s specific instructions.
Fever readings for a baby under 3 months old:
First, ask your child’s healthcare provider how you should take
Rectal or forehead: 100.4°F (38°C) or higher
Armpit: 99°F (37.2°C) or higher
Fever readings for a child age 3 months to 36 months (3
Rectal, forehead, or ear: 102°F (38.9°C) or higher
Armpit: 101°F (38.3°C) or higher
Call the healthcare provider in these cases:
Repeated temperature of 104°F (40°C) or higher in a child of any
Fever of 100.4° (38°C) or higher in baby younger than 3
Fever that lasts more than 24 hours in a child under age 2
Fever that lasts for 3 days in a child age 2 or older
- Croup is a common infection in
children. It is most often caused by a virus. It causes swelling in the upper part
the airway in the neck.
- Children with croup have trouble
breathing because their small airways swell.
- Common symptoms include a barking
cough, fever, runny nose, and high-pitched “creaking” or whistling sound (stridor)
when breathing in.
- Most cases are mild and can be managed
at home. A child who has a lot of breathing problems may need to go to the
- Correct handwashing is one way to
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a
new diagnosis and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.