Croup

Introduction Audio

Croup is a common childhood illness that causes a bark like cough. It can also cause difficulty breathing which can be frightening for both you and your child.

Croup is caused by a virus which affects the airways including the voice box (larynx), windpipe (trachea) and lungs (the bronchi) causing them to swell and become narrower.

Some children have croup two or more times in their childhood.

Please see Red-Amber-Green tables for advice on when and where to seek care for your child.

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When should you worry?

RED

Red Audio

If your child has any of the following:

Breathing very fast, too breathless to talk, eat or drink
Working hard to breathe, drawing in of the muscles below the ribs
Breathing that stops or pauses
A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)
Drooling more than normal and struggling to swallow their own spit
Is pale, blue, mottled and/or unusually cold to touch
Difficult to wake up, very sleepy or confused
Has a fit (seizure)
Has a rash that does not go away with pressure (the glass test)

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or call 999 - dial 999.

AMBER

Amber Audio

If your child has any of the following:

Breathing a bit faster than normal or working a bit harder to breathe
A harsh noise as they breathe in (stridor) only when upset
Dry skin, lips or tongue
Not had a wee or wet nappy in last 8 hours
Temperature of 38^oC or above for more than 5 days or shivering with fever (rigors)
Temperature less than 36°C in those over 3 months
Getting worse and I am still worried

You need to contact a doctor or nurse today.

Please contact your GP surgery or call NHS 111 - dial 111.

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

AMBER

Green

Green Audio

If your child has none of the above

Watch them closely for any change and look out for any red or amber symptoms
If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111.

Self care and Prevention

What are the symptoms of croup?

A cough. The cough is usually harsh and barking. This ‘croupy cough’ is due to inflammation and swelling of the vocal cords in the voice box (larynx).
Noisy breathing. The infection can narrow the voice box (larynx) and windpipe (trachea) and cause an extra noise called a stridor. This noise is normally heard on breathing in.
Breathing may become difficult if the narrowing becomes worse.
Your child may also have a runny nose, hoarse voice, sore throat, high temperature (fever), general aches and pains and be off their food. Croup may follow a cold but can also appear without any earlier illness.
The symptoms of croup appear worse at night. A mild but irritating cough may persist for a further week or so.

How can I help my child?

Stay calm. This will help keep your child calm. Children with croup may become upset. Crying may make their symptoms worse.
Sit your child upright on your lap if their breathing is noisy or difficult. Let them find the most comfortable position.
Encourage your child to drink cool drinks regularly (little and often) to help soothe their throat and keep them hydrated.
If your child seems to be in pain or discomfort, you can give your child Paracetamol or Ibuprofen, following the instructions on the container.
If their temperature is high, dress them in cool, loose clothes (if any) and don’t use anything warmer than a sheet to cover them in bed.
Stay with your child or check him or her regularly. You need to know if the symptoms are getting worse.
Some people find that taking their child outside in the cool, fresh air helps to relieve their symptoms.
There is no evidence that steam inhalation helps. There is a risk of scalds if steam is used.
Do not give cough syrup. It is not recommended for children under 6 years. It can make children sleepy and does not help croup.

How is croup treated?

Your child may be given a steroid medicine called dexamethasone or prednisolone which can reduce airway swelling.
As croup is caused by a viral illness antibiotics are not needed.