Is my child’s cough croup? Symptoms, treatment and when to call the doctor

A cough with a distinctive sound and raspy breathing could mean croup. GP Dr Lowri Kew explains the symptoms (with coughing sounds to listen to) and what to do next

Baby coughing

Croup is an infection caused by a virus, which affects babies’ and children’s airways and voicebox. It occurs most frequently in the late autumn and early winter.

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What are the symptoms of croup?

Croup has one very distinctive feature – the cough, which sounds like a seal barking.
Listen to the sounds of a baby and a young child with a croup cough
But there are other symptoms too. The common signs of croup are:

  • Loud, harsh cough best described as sounding like a barking seal, which can come on suddenly. This is often worse and more frequent at night
  • Noisy, laboured breathing, which can sound raspy or high-pitched when your child is breathing in. This is called stridor – listen to the sounds of stridor 
  • First symptoms may be a cold with a stuffy or runny nose and mild temperature. The cough may develop after a few days
  • Your child may also have a hoarse, croaky voice, feel achy and lose their appetite
Your child’s croup cough is often worse at night

My child sounds like they can’t breathe properly – should I call an ambulance?

Even mild croup can seem very frightening – especially when it happens in the middle of the night – because it can affect your child’s breathing. Although it’s distressing, try to stay calm, though we know it’s not easy when you may be half asleep yourself and help is not neccessarily instantly at hand.

Croup causes the airways to become swollen and inflamed, and this can make breathing more difficult for your child. They’ll have more trouble breathing in than out.

As they make more effort to breathe they’ll also start to use more muscles and you may see the soft tissues between their ribs or neck pull inwards.

Call NHS111 or see a GP if:

  • they get worse
  • symptoms haven’t improved after 48 hours
  • you’re feeling worried

Take your child to A&E or call 999 if:

  • they struggle to breathe (you may hear their breathing sounds different or see their tummy sucking inwards)
  • they suddenly get a very high temperature
  • they become drowsy or their skin or lips become blue
  • they go unusually quiet or still

About one in 10 children need hospital admission – oxygen may be needed and steroid medicine given – but the hospital stay is usually brief. Only one in 100 children have more severe croup requiring further support. Occasionally, a secondary infection, such as pneumonia, may occur.

“My 3-year-old son developed a terrible cough at about 10pm one evening,” recalls MadeForMums editor Susie. “It seemed to come out of nowhere and over 30 minutes it just got worse and his breathing became really heavy.

“We rang NHS 111 and they asked if the sound in the background was my son breathing. When I said it was, they called an ambulance. As the paramedics came up the stairs, my son coughed and one said instantly, ‘Ah, that’s croup.’

“They still blue-lit us to the hospital but we were discharged a few hours later. My son was back to full health within a couple of days, but loved the fact that he’d been in an ambulance going Wooh wooh with the blue flashing lights.”

How to treat croup at home

Sit your child upright to help them breathe more easily. Give them plenty of water (or other fluids if they don’t want water) to drink. Give them lots of reassurance and keep them calm – their symptoms could get worse if they’re agitated or crying.

Don’t be tempted to give them cough medicine.

Most mild cases of croup need no medical treatment and clear up on their own. Make sure you avoid smoky atmospheres and encourage your little one to drink between coughing to prevent dehydration.

Croup affects about 2% of children under 5 every year

“Steven had croup when he was 18 months,” shares mum Charmaine. “At first I thought he had a cold, but then one evening he started this awful barking cough – it sounded frightening, although he didn’t seem that unwell. We rang NHS 111, who told us to give him paracetamol, keep him calm, monitor him regularly and take him to the doctor the next day. We did – but he was better by then.”

I’ve heard that I should put a child with croup in a humid room – like a bathroom where the hot water has been running. Is this correct?

This is an old home remedy that in the past was sometimes even advised by health professionals but it is now NOT recommended. There is no evidence that getting your child to breathe in humid air has any benefit and so the NHS states: “Do not put your child in a steamy room or get them to inhale steam.”

The NHS advises NOT to put your child in a humid or steamy room

How long do symptoms of croup last for?

Croup symptoms usually peak after one to three days and then start to improve. Your child’s cough may last for a further week or so.

Celebrity mum and singer Frankie Bridge shared her experience of her son having croup on Instagram.

“The face of a proud emotionally drained Mum who’s child has been really poorly and scared her half to death and a child who is the prime example of how well and quickly they bounce back.

“This little man is so full of love and this surprise hug felt more amazing than he will ever know. Not sure who was looking after who. Croup is not our friend.”

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Who gets croup?

Croup is a childhood illness which mainly affects:

  • Children between the ages of 6 months and 5 years
  • Less common, croup can affect babies from 3 months and children up to 15 years. Even adults can get croup, but it’s rare
  • Croup is most severe in children under 3 because their airways are still narrow
Did you know? Croup is more common in boys

Can a child get croup more than once?

Yes, some children seem to be more susceptible to croup and may get it every autumn or winter. However, as your child’s windpipe matures and gets wider, the symptoms will start to reduce.

“When Oliver was 9 months, he caught a cold and cough, which turned into a barking cough,” says Frankie from Sussex, mum to Oliver, 3, and Tobias, 5 months.

“He was finding it hard to breathe so we took him to A&E where he was given steroids and an inhaler for croup.

“He’s 3 now and tends to get croup when he’s got a cold, so we use try to catch it as early as possible. We always reassure him it will pass in time, and only have to use the steroids and inhalers if it gets really bad.”

How do you stop your child getting croup?

Unfortunately there’s no way to prevent your child getting croup, although washing your hands does help stop the spread of the virus that causes it.

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Image credits: Getty Images, Frankie Bridge on Instagram

Dr Lowri Kew is a practising GP in Devon. She is a contributing author of Your Baby’s First Year: Month by Month (Hamlyn) and one of her specialisms is teenage health.

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