Croup in Children: The Barking Cough Explained

Few sounds wake a parent faster than a child who suddenly coughs like a barking seal at two in the morning. That harsh, honking cough is the classic sign of croup. It can be scary to hear, but most cases are mild and get better at home within a few days. This guide explains what croup is, why it tends to flare at night, how to calm your child, and which breathing signs mean you need help right away.

What croup is

Croup is swelling of the voice box (larynx) and windpipe (trachea), usually caused by a common cold virus. In young children these airways are narrow to begin with, so even a little swelling makes air squeeze through a tighter space. That squeeze is what creates the bark and the hoarse voice.

Croup is most common in children between about 6 months and 3 years old, though older kids can get it too. It shows up most often in fall and winter, but it can happen any time of year.

Symptoms to know

Croup often starts like an ordinary cold, with a runny nose and maybe a low fever. After a day or two, other signs appear:

• A loud, barking cough
• A hoarse or raspy voice or cry
• Stridor: a high-pitched, squeaky or harsh sound when your child breathes in
• Fever, which is usually mild

Symptoms are often worst on the first two or three nights and then ease. Most children are back to normal in about a week, although a mild cough can hang on a little longer.

Why it gets worse at night

Many parents notice their child seems fine during the day and then wakes up barking and upset. Doctors think several things play a part, including the body's natural daily rhythms, lying down, and the fact that crying makes the airway work harder. The key thing to know is that a rough night does not always mean your child is getting sicker overall. Watch the breathing, not just the cough.

How to calm your child during an attack

Crying and panic make the airway narrow even more, so your calm is one of the most useful tools you have.

1. Stay calm and hold your child. Sit upright with them on your lap or against your chest. A quiet song or story can help.
2. Try cool air. Some parents find that bundling up their child and stepping outside into cool night air for a few minutes helps. A cool-mist humidifier in the bedroom may also make your child more comfortable. Research on mist is mixed, so do not count on it alone.
3. Skip hot steam. Never hold your child over a pot of boiling water or a very hot shower. Burns from hot water are a real risk.
4. Offer fluids. Small sips of water or other drinks keep your child hydrated and can soothe a sore throat.
5. Treat fever and discomfort. Acetaminophen, or ibuprofen for babies 6 months and older, can help your child feel better. Ask your pediatrician or pharmacist for the right dose based on your child's weight. Never give aspirin to children.

Over-the-counter cough and cold medicines are not recommended for young children and do not treat croup. Talk with your pediatrician before giving any of them.

Noisy breathing at rest is the warning sign

A child with croup may make a squeaky sound when crying or coughing hard. That is common. What matters more is the sound when your child is calm and quiet. Stridor while resting or sleeping means the airway is quite narrow, and your child needs to be seen.

Also look at how hard your child is working to breathe. Signs of trouble include:

• Skin pulling in between the ribs, above the collarbone or at the base of the throat with each breath
• Nostrils flaring
• Breathing much faster than usual
• Trouble talking, crying or drinking because breathing takes so much effort
• Restlessness or agitation that does not settle with comfort

What the doctor may do

Croup is usually diagnosed by listening to the cough and breathing and examining your child. X-rays and lab tests are rarely needed.

Because croup is caused by a virus, antibiotics do not help. For many children, the main treatment is a single dose of a steroid medicine, often given by mouth. It works by bringing down the swelling in the airway, and it can make the next few nights easier. For more serious breathing trouble, children may get a breathing treatment with a medicine that shrinks the swelling quickly. They are then watched for a few hours to make sure the effect holds. A small number of children need to stay in the hospital for oxygen or closer monitoring.

A few other conditions can look like croup, such as a swallowed object stuck in the airway or a rare throat infection. That is one more reason to have your child checked if things do not seem typical. You can read more about croup on MedlinePlus's croup page and find general guidance on children's breathing illnesses at HealthyChildren.org from the American Academy of Pediatrics.

Can croup be prevented?

You cannot avoid every cold virus, but you can lower the odds. Regular handwashing, covering coughs and keeping your child away from people who are sick all help. Keep your child away from cigarette smoke and vaping, which irritate the airway. Staying up to date on the vaccines your pediatrician recommends also protects against some illnesses that cause breathing trouble.

When to call us

Call your A thru Z Pediatrics office if:

• Your child has stridor while calm, even if it comes and goes
• The barking cough lasts more than a week or keeps coming back
• Fever lasts more than three days or your child seems to be getting worse
• Your child is not drinking well or has fewer wet diapers or trips to the bathroom
• Your baby is younger than 6 months and has croup symptoms
• Your baby is under 3 months and has a temperature of 100.4°F or higher. Call right away.

Call 911 or go to the nearest ER if your child is struggling to breathe, has lips or skin that look blue or gray, is drooling or cannot swallow, cannot speak or cry, is very sleepy or hard to wake, or has loud stridor that does not ease after a few minutes of calming.

For anything that is not an emergency, you can request a visit online.