Croup in Kids: Symptoms, Treatment & When to Seek Care

What Is Croup?

Croup is an upper respiratory infection that irritates and swells your child’s larynx (voice box and upper airway. That swelling can make it harder for air to move in and out, which is why croup often causes a harsh, barking cough and noisy breathing.

Croup is most common in babies and young children. While a barking cough is often a sign, it can sometimes be hard to tell if it’s croup or another illness. Heather M. Thomas, MD, a pediatric pulmonologist with Children’s Nebraska, shares tips on spotting a croup cough, caring for your child at home and knowing when to see a doctor.

How to Spot a Croup Cough and Other Symptoms of Croup

A classic croup symptom is a “barking cough that usually happens in the middle of the night and comes on unexpectedly,” says Dr. Thomas. Some parents describe it as a barking seal cough.

Other croup symptoms to watch for in babies and toddlers include:

• Difficulty breathing

• Fever

• Hoarse or raspy voice

• Nasal flaring

• Red eyes

• Retractions, when the skin around your child’s ribs sucks in when they breathe

• Stridor, or noisy breathing, that may sound like a whistle, or be raspy, high-pitched or vibrating

• Swollen lymph nodes

• Symptoms that are often worse at night

Home Remedies for Croup

If you wake up in the middle of the night to the sound of a barking cough, check on your child.

“Try to keep them calm, hold them, keep them comfortable,” Dr. Thomas says. “A lot of parents say they’ll go into a steamy shower room, and I think that helps. Usually it’s just symptomatic control. Take care of the fever with acetaminophen or ibuprofen, make sure they’re drinking enough and keep them calm.”

When to Go to the Pediatrician for Croup

Contact your child’s pediatrician if your child is experiencing any of these symptoms:

• Barky cough when they’re under 1 year old

• Cough along with vomiting

• Earache

• A fever that’s recurring or has lasted for several days

• Nonstop coughing

Your child’s pediatrician will diagnose croup by observing your child’s breathing, using a stethoscope to listen to their chest and examining their throat.

Depending on the exam, the pediatrician may recommend:

• Additional at-home treatments to try

• Medicines, such as a corticosteroid (to reduce swelling in your child’s airway)

If your child is struggling to breathe, the pediatrician will recommend that you take your child to an urgent care center such as Children’s Care Today or the Emergency Department for further evaluation.

When to Seek Urgent or Emergency Care for Croup

When Dr. Thomas gets a call from a parent whose child has a barky cough, she recommends paying attention to their level of distress.

“If it’s just a barky cough and the child otherwise looks fine, then you can probably just do symptomatic management — cautious waiting and watching,” she says. “But if it’s more than that, you need to go to urgent care or the Emergency Department.”

Look for signs that your child is having trouble breathing.

“They’re pulling in underneath the ribs,” Dr. Thomas says. “They’re struggling to breathe. They’re breathing fast. They’re breathing hard. You might see what we call nasal flaring, where the nose moves in and out. All of those are indicators of respiratory distress.”

If your child is turning blue, seek emergency care right away.

ER for Croup: What to Expect

When you and your child arrive at the Emergency Department, our care team will do a quick assessment to determine how quickly they need to be seen. Then, we’ll monitor their oxygen levels, heart rate and breathing. Croup treatments may include:

IV fluids if there are signs of dehydration

Medications, including steroids and/or epinephrine, which is inhaled through a mask

“If it’s a normal presentation and they respond to typical treatments, then the Emergency Department physician may be the only provider they see ,” says Christopher W. Edwards, MD, a Children’s Nebraska pediatric hospital medicine expert.

After your child is discharged from the Emergency Department, he recommends following up with your child’s pediatrician within the next 48 hours.

Can Croup be Life-Threatening?

Severe croup can be life-threatening, but this is rare. The American Academy of Pediatrics notes fewer than 5% of children with croup are admitted to the hospital.

“If it’s a truly life-threatening situation, we will admit your child to our hospital,” Dr. Edwards says. “In very rare cases, they may need to be intubated and put on a ventilator to help them breathe.”

Sometimes croup may not be life-threatening, but inpatient care is still necessary.

“If your child’s oxygen levels are low and they need oxygen, then they’re going to get admitted,” Dr. Thomas says. “If they can’t keep themselves hydrated, then they’re going to get admitted. So it’s not necessarily just that they have a croupy barky cough, it’s how that cough is affecting the rest of their body.”

While a hospital admission can be a high-stress situation for families, you can count on our pulmonary and hospital medicine experts to provide compassionate, collaborative care with the goal of getting your child home as soon as possible.

Why Is My Child Being Referred to an Expert for Croup?

“If your child has frequent episodes of croup, the episodes are atypical, the croup doesn’t respond to traditional therapies or your child continues to have episodes of croup as they get older, we may refer you to one of our pediatric pulmonary experts,” Dr. Edwards says.

What is Recurrent Croup and Atypical Croup?

Recurrent croup is when a child has more than two episodes of croup in one year. Atypical croup is when an older child experiences episodes of croup or when croup doesn’t respond well to typical croup medication. Recurrent croup and atypical croup aren’t diagnoses. Rather, they’re signs something else may be going on.

“Sometimes children who have recurrent croup actually have some underlying airway reactivity, which is usually asthma” Dr. Thomas says.

Comprehensive, child-focused testing for lung and breathing disorders can help find the cause of your child’s frequent or atypical croup episodes.

“If we think there may be an airway anomaly, our pulmonologists may team up with our otolaryngologists (ENT or Ear, Nose and Throat experts),” Dr. Edwards says. “If we suspect reflux is a contributing factor, our pulmonologists may team up with our gastroenterologists (GI experts).” Triple scopes may be recommended after the acute illness resolves.

How Can You Prevent Croup?

Croup is highly contagious. Dr. Thomas recommends reminding your child to practice good hand hygiene, including washing their hands often and using hand sanitizer. Try to avoid people who are coughing or sick, and if your child is in daycare or school, don’t send them if they’re sick.

“But you can’t live in a bubble,” Dr. Thomas says. “I feel like some parents and families beat themselves up because their child is in daycare and gets sick a lot, but it is what it is. When talking about croup, most kids are going to be just fine and grow up and do great things.”

Comprehensive Croup Care You Can Count On

At Children’s Nebraska, your child has access to the most comprehensive pediatric pulmonary program in the region with a state-of-the-art pulmonary diagnostic lab. Our pulmonary experts consult with providers across specialties, giving your child access to multispecialty care in one location.