Croup: The Bark You Will Recognise

Croup announces itself with a cough that sounds like a seal barking, usually in a child between six months and three years, and usually at night. It is caused by swelling around the vocal cords, which is why the sound is so distinctive and why the first night is often the worst.

What to expect

Most croup begins as a cold, then brings the barking cough, a hoarse voice and noisy breathing on the in-breath, called stridor. Symptoms typically worsen over two or three nights and then settle, with the cough lingering for a week or so. The swelling is worst in the small hours, which is why parents so often end up awake at 2 a.m. wondering whether to drive to hospital.

• Stridor at rest, or a child struggling to breathe, needs urgent assessment.
• Drooling, difficulty swallowing or a very still, quiet posture are emergency signs.
• A single dose of oral steroid from a doctor reduces severity in most cases.
• Steam and cold night air may soothe a cough but do not treat the swelling.

What helps, and what to do

Keep the child calm, because crying narrows the airway further. Sitting them upright on your lap, in a steamy bathroom or in cool night air, often eases the breathing for a while. Most children with croup are given a single dose of oral dexamethasone, which is effective and well tolerated, and some need adrenaline nebulisers in hospital. Antibiotics do not help, since it is viral. Paracetamol can be given for fever and discomfort.

Call for help immediately if the child is struggling to breathe at rest, is pale or blue, is unusually quiet and still, or is drooling and unable to swallow. If the noisy breathing settles when they are calm and only appears when they cry, a same-day appointment is reasonable. Most croup resolves in a few nights, and the child is back to themselves long before the cough is.