Croup

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

What is croup?

Croup (also called laryngotracheobronchitis) can be caused by several viruses which affect the airways including the voice box (larynx), windpipe (trachea) and lungs (the bronchi) causing them to swell and become narrower. It usually affects babies and young children between the ages of one and three years old. Some children have croup two or more times in their childhood.

What are the symptoms of croup?

Your child may have:

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 symptoms – the inflammation 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.
Other symptoms – these may include a runny nose, hoarseness and a sore throat. Croup may follow a cold but can also appear without any earlier illness. Children may also experience a high temperature (fever), general aches and pains and be off of their food.
The symptoms of croup appear worse at night. They usually peak after one to three days and then improve. A mild but irritating cough may persist for a further week or so.

When should you worry?

RED

If your child has any of the following

Breathing very fast or breathing that stops or pauses
Working hard to breathe, drawing in of the muscles below the rib or unable to talk
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
Becomes pale, blue, mottled and/or unusually cold to touch
Difficult to wake up, very sleepy or confused
Weak, high-pitched, continuous cry or can’t be settled
Has a fit (seizure)
Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red or amber features)
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 phone 999.

AMBER

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
Poor feeding in babies (less than half of their usual amount)
Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
Is 3-6 months old with temperature 39^oC or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
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 ring your GP surgery or call NHS 111 - dial 111.

‍

Green

If your child has none of the above

Watch them closely for any change and look out for any red or amber symptoms
Additional advice is also available for families for help cope with crying in otherwise well babies
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.

Advice and Guidance

Self care and Prevention

How can I help my child?

Stay calm in order to reassure your child – children with croup may become distressed and 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.
Give your child paracetamol or ibuprofen liquid, following the instructions on the bottle.
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, as 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