Croup can be a very scary experience for parents.  Your child may have a cold and suddenly develop a hoarse voice, noisy breathing, and a telltale barky cough.  It often sounds worse than it really is but can be distressing for both parents and children.  

What is Croup?

Croup is an infection most commonly caused by respiratory viruses.  These viruses cause inflammation and swelling of the throat, vocal cords (larynx), and the large upper airways.  The swelling is what makes breathing noisy and difficult.  Children between the ages of 3 months and 5 years are most likely to get croup because their airways are smaller.  

It most commonly occurs in the winter months and just like the common cold or COVID-19, will spread by touching someone who has the virus, or a surface that an infected person may have touched, or by coming into contact with the virus in the air through droplets after a cough or sneeze.  

Symptoms of Croup

Croup usually starts out with the usual cold symptoms.  But children with croup will develop:

  • Fever
  • Barky sounding cough that worsens at night time
  • Hoarse voice
  • Noisy breathing called inspiratory stridor is a hoarse sound when your children breaths in

The cough usually resolves after about 48 hours.  Most symptoms of croup are gone within 7 days.  

Treatment of Croup

Because croup is caused by a virus, most of the treatment is aimed at symptom management.  

  • Keep your child calm and comfortable.  Increased activity  or even crying can make breathing more difficult because of the airway swelling. 
  • Fever can be treated using acetaminophen or ibuprofen (if your child is older than 6 months).  
  • Encourage lots of fluids.
  • Treat your child’s cold symptoms as usual.  Avoid using cough and cold medicines in children under 6 years of age.  
  • Take your child outside if it’s a cold winter day.  The cool air can help with breathing.  

Sometimes physicians may prescribe a one-time dose of dexamethasone or prednisolone for your child.  These are corticosteroid medicines that reduce the swelling in the airways.  

Antibiotics are not required for the treatment of croup.

When To See A Doctor

Croup symptoms should be monitored closely.  If you are worried that your child is not improving or if your child has any of the following symptoms, please contact your doctor or visit the emergency department.

Concerning symptoms that require a physician assessment:

  • Noisy inspiratory stridor even at rest
  • Difficulty breathing, or rapid breathing, or lips/fingernails turning blue
  • Not able to take in any fluids
  • Drooling a lot
  • Cannot lie down because it makes breathing more difficult
  • Lethargic, drowsy and listless

Croup is a common illness in childhood, and most cases are mild and can be treated at home.  If you have any concerns about your child’s breathing, contact your doctor. 

This post was co-authored by Erin Manchuk, BScPharm, BCGP and Stephanie Liu, MD, MSc, CCFP, BHSc.