Croup | Mate maremare pēpē

Key points about croup

  • Croup is a viral illness that causes narrowing of the upper airways.
  • Croup is often worse at night.
  • Croup is often a mild illness but can quickly become serious, so do not wait to get medical help.
  • There is effective treatment for severe episodes of croup.
  • Steam doesn’t help and may lead to accidental burns – don't use it.
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COVID-19 information

If you have any respiratory symptoms such as a cough, sore throat, shortness of breath, head cold or loss of smell, with or without fever, stay at home and test for COVID-19.

Call an ambulance on 111 for emergency help if your child

  • has blue or dusky coloured lips (may occur after a coughing spell)
  • is not breathing continuously
  • is having extreme difficulty breathing
  • seems confused or drowsy.
See a doctor urgently if your child has any of the following symptoms:
  • has stridor (a harsh noise heard when breathing in) when they are calm and not upset
  • starts dribbling or cannot swallow
  • cannot bend their neck forward
  • is not having enough fluid
  • has a high temperature
  • develops earache
  • is having difficulty breathing
  • you are concerned that your child is getting worse.

For further information and support talk to your doctor or practice nurse. You can also phone Healthline(external link) on 0800 611 116 for advice.

Croup is a viral illness in young children, which causes narrowing of the upper airways. Some children have recurring croup and this may need further assessment. This video may take a few moments to load.

Source: Armando Hasudungan(external link)(external link) YouTube 

When you breathe, air passes through the voice box (larynx) and windpipe (trachea) into the lungs. In croup, a viral infection causes inflammation and swelling of the lining of the voice box and windpipe, which become narrowed. When the airway becomes narrowed, breathing in becomes more difficult, and you can hear stridor (a harsh noise when breathing in).

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Image credit: 123rf

Babies and children 6 months to 3 years are at most risk of getting croup, but children who are younger or older can also get it. As children grow, their windpipe strengthens, lessening their chance of getting croup. It is common in the autumn and spring. 

Croup is usually caused by a viral infection. If your child has repeated occurrences of croup (more than 1 per year), or is under the age of 6 months or over the age of 6 years and gets croup, you should contact your doctor. Your doctor may arrange further investigation or refer you to a specialist to see if there is another cause. 

Croup often starts like a common cold with a slight fever, red eyes, sore throat and runny nose.

  • After a few days, other symptoms develop including a barking, seal-like cough and raspy noise when they breathe in (stridor).
  • Symptoms are almost always worse at night and crying generally makes the barking cough and noisy breathing worse.
  • Croup is usually worse on the 2nd or 3rd night and can last up to a week, though the cough can last longer. As the child gets better, the cough will usually become looser.
  • Croup is contagious for about 4 to 6 days and is spread by droplets in the air from coughs and sneezes.

Some children can have a form of croup that comes on quickly, often at night, but also resolves after about an hour or so. These children may be more likely to already have asthma or to develop asthma.

KidsHealth has plenty ofuseful information and videos with signs that children are struggling to breathe(external link)(external link).

Video: Doctor explains Croup with real example of Croup sounds! | Barking Cough in children

This video may take a few moments to load.

 Source credit: Doctor O'Donovan(external link)(external link) , YouTube 2021

The treatment of croup depends on how severe the illness is. Because croup is caused by a virus, a mild case will usually clear up on its own. You can use simple self-care measures such as those listed in the table below to keep your child comfortable. Moderate to severe cases need observation in hospital, often overnight. 

Simple measures to keep your child comfortable

Keep your child calm and comfortable Try to keep your child calm with cuddles and reassurance. Children are often more comfortable in the upright position. Sit toddlers and small children up with pillows. Babies may rest more comfortably in their car seat or stroller in the upright position.
Stay with your child when coughing Croup can be frightening for the parent and the child. Stay with your child all the time when they are coughing. Handle him or her gently, and talk quietly and firmly. The symptoms of croup will be worse if the child is upset and feels that you are not in control.
Keep your child hydrated Encourage your child to drink small sips of fluids regularly, to help soothe their throat and keep them hydrated.
 Give simple pain relief  You can give your child simple pain relief such as paracetamol if your has a fever or a sore throat. Follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.

What not to do

  • Don't use steam. It can be dangerous for your child because of the possibility of burns or scalding.
  • Don't put anything in your child's mouth to look at their throat. This may make symptoms worse.
  • Do not give your child cough medicines. These will dry the mucus, making the airways even smaller.

Apps reviewed by Healthify

You may find it useful to look at some Baby care apps and First aid and emergency apps.

  • Paracetamol can be given if your child has a fever or a sore throat.
  • Sometimes steroids (prednisolone) taken by mouth are given for croup. The steroids help reduce the swelling in the airways and this will make breathing easier.
  • If the croup is very severe, your child may be given nebulised adrenaline which reduces the airway swelling and makes breathing easier.
  • Antibiotics are not used to treat croup unless your child develops a bacterial infection as well. This can be diagnosed by your doctor.

The following links provide further information about croup. Be aware that websites from other countries may have information that differs from NZ recommendations.   

Croup(external link)(external link) KidsHealth NZ
Signs that children are struggling to breathe(external link)(external link) KidsHealth NZ
Croup(external link)(external link) Asthma + Respiratory Foundation NZ
Croup(external link) Health New Zealand | Te Whatu Ora

Apps

Baby care apps
First aid and emergency apps

Resources

What is croup?(external link)(external link) Asthma Respiratory Foundation NZ, 2010

Clinical pathways and guidelines

Croup(external link) Auckland Regional HealthPathways, NZ, 2020
Croup(external link) Starship Clinical Guidelines, NZ, 2020

Listen to the concerns of parents

The following tips from BPAC are also useful.

Cough in children, regardless of the underlying reason, can cause significant distress, disruption of daily activities and a lack of sleep for both the child and the parents. Ask open questions following the standard FIFE format, such as:

  • Feelings: What are your concerns?
  • Ideas: What do you think is the cause of the cough?
  • Function: How is the cough affecting your child and yourself?
  • Expectations: What do you think is needed to help resolve the cough?

Responses to these questions should help uncover parental concerns, suggest areas requiring further direct questioning and guide the type and range of advice given. In many cases the answers may also reveal the likely diagnosis.

See more: Cough in children(external link) BPAC, NZ, 2010

Use of steam – why is it no longer recommended?

A meta-analysis in 2006 concluded, "We have been unable to find evidence that the croup score of children managed in an emergency setting with mild to moderate croup improves substantially with inhalation of humidified air. There is no evidence to guide treatment in primary care. In the ED, however, there is clear benefit from the administration of nebulized or oral steroids and there is no justifiable reason to continue to offer standard humidification as a mainstay of treatment".

Moore M, Little P. Humidified air inhalation for treating croup: a systematic review and meta-analysis(external link) Family Practice. 2007;24(4):295-301. 

Apps

Baby care apps
First aid and emergency apps

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Alice Miller, FRNZCGP

Last reviewed:

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