Croup - causes, symptoms and treatment

Baby coughing

Croup is very common in young children but it can be one of the most frightening for parents to watch. The first time you hear that barking croup cough it sounds incredibly worrying – particularly if your child is also having breathing difficulties. Be assured, after a quick trip to the doctor, most cases of croup can be treated at home and disappear over a few days.

What is croup?

Croup is a fairly common respiratory problem that affects babies and toddlers. It involves swelling in the bronchi (airways to the lungs), trachea (windpipe) and larynx (voice box). A child with croup will have a harsh, bark-like cough and make a rasping noise, known as stridor, when they breathe in.

It's alarming to watch but, on the whole, croup sounds worse than it is. Literally, its bark is worse than its bite. The adult version of croup is laryngitis, so if you’ve ever suffered from that you’ll have some idea of what your child is feeling.

Most cases last a few days – two weeks tops – and there should be no lasting damage.

Our son woke in the night with a horrible cough and was struggling to breathe. We took him to A&E. The doctor said he had croup. They gave him a steroid and sent us home. In the morning, my son was okay and had just a normal-sounding cough.

If you think your child has croup then take her to your doctor. It will be reassuring to get the problem diagnosed and get the medication that will put your baby on the path to recovery. This is all that’s required to treat mild cases of croup. Some severe cases require hospital treatment but these are in the minority.

There is no need to be alarmed by croup but you should be proactive in getting your child treated. If you're concerned that she might be suffering from the severe form of croup, don't be afraid of overreacting – get her to a doctor who will be able to help quickly.

Is croup contagious?

Yes. Croup spreads like the common cold so you can get it more than once (it's most common in autumn and winter) and you can even get it twice in one season. If your child has croup then you should keep her at home until she's better. While you can't prevent her getting croup, some of the vaccines your child will be offered will protect her against some of the diseases that can cause croup.

What causes croup?

Croup is usually caused by viruses. Parainfluenza I is responsible for most cases (there are four strains of Parainfluenza and the other three are involved in a small percentage of cases). Other common causes of croup include:

  • Flu viruses
  • Measles (in children who haven’t been vaccinated against measles)
  • Common cold virus
  • Enteroviruses
  • Respiratory Syncytial Virus (RSV) which can cause severe breathing problems and, in babies, pneumonia.

Less common causes include:

  • Allergic reaction to pollen or dustmites
  • Acid leaking back out of the stomach and into the throat (reflux)
  • Epiglottitis – inflammation of the flap at the base of the tongue (epiglottis) that keeps food from going into the windpipe
  • Inhalation of chemicals
  • Inhalation of a small object, such as a pen cap or peanut.

What are the symptoms of croup?

The most obvious sign of croup is the distinctive cough. It can shred your nerves but at least the bark-like sound will leave you in no doubt about what the problem is. Mumsnetters often say that, if your baby has croup, you’ll know about it.

The cough sounds similar to a dog barking. The more upset the child becomes, the worse the barking becomes, and they can struggle to catch their breath.

Most cases of croup occur during the autumn and winter and the following symptoms are most likely to come on at night:

  • Coughing
  • Fever
  • Runny nose
  • Sore throat
  • Stridor (wheezing/rasping)
Baby coughing

What is the best treatment for croup?

The way your child’s croup is treated will depend on the severity so take her to the GP. In the vast majority of cases, treatment at home will be sufficient. However, in severe cases, hospitalisation might be required.

How are mild cases of croup treated?

Mild cases of croup are by far the most common and can usually be treated at home. Take your child to your GP as soon as possible. The doctor will probably prescribe children’s paracetamol to ease the pain and reduce your child’s temperature.

Ask the doctor if you’re unsure about what other painkillers can be given to children – and never give aspirin to a child under the age of 16.

The doctor might also prescribe a single dose of steroids to help reduce swelling in your child’s throat. This will make your child more comfortable but side-effects can include:

  • Vomiting
  • Headaches
  • Upset stomach
  • Restlessness

Along with giving your child the prescribed medicines, there are plenty of things you can do to ease her pain and comfort her while she recovers. Sitting her upright on your lap will help her breathing and she will appreciate the emotional support that comes with a good cuddle. Give her plenty of fluids to drink, as this will soothe her sore throat and help prevent dehydration.

Some Mumsnetters say that moist or cold air can help to reduce swelling in the airways. They recommend taking your child into a steamy bathroom, where you run a hot bath or leave the shower on, and letting her breathe the steamy air. Alternatively, you could wrap her up and take her outside on a cool night to see if the cold air helps.

There's no hard evidence to indicate that the steam/cold air techniques work and even their advocates acknowledge that they won’t cure croup and are simply quick fixes to ease coughing and breathing difficulties, but it's worth a go and may give your child a bit of relief from the coughing.

How are severe cases of croup treated?

Even if your child has been diagnosed with a mild case of croup, you should monitor her symptoms to see how she responds to treatment. If you think she’s getting worse and not better, return to the doctor immediately and see if they think she might be suffering from a severe case of croup that requires hospital treatment.

If she is struggling to breathe then call an ambulance immediately.

We called an ambulance for my son when he was unable to breathe with croup. Don't be afraid to go to A&E or call an ambulance if your child is having difficulty breathing.

At the hospital, the doctors’ priority will be to stabilise your baby’s breathing. If she’s distressed, then she might be given an oxygen mask. Otherwise, she will probably be given adrenaline through a nebuliser (this device turns medication into a fine mist which your baby can breathe in). This treatment should have an immediate effect and get her breathing steadily within 30 minutes.

In rare cases, intubation might be required. This is when a tube is inserted into the windpipe, via the mouth or a nostril, to help the child breathe. Distressing as this might be, it will at least be done under general anaesthetic, so the child will be unconscious during the procedure and unaware of what’s going on.

This sounds frightening, but croup-related mortality rates are extremely low and the vast majority of children make a full recovery. Mumsnet Talk is an excellent place for discussing your worries or experiences with other parents who’ve been there – and it's open 24/7.