Croup has a way of showing up at 2 a.m. Your child goes to bed with a runny nose, and a few hours later you wake to a cough that sounds like a seal barking. Their voice is hoarse, and each breath in comes with a squeaky, raspy sound.
It’s scary to hear, but most croup is mild and gets better at home within a week. We see a lot of it at Indian Crest Pediatrics once fall arrives, mostly in toddlers and preschoolers. Knowing what’s typical, and what isn’t, makes those late nights a lot easier to handle.
What Is Croup?
Croup is swelling of the voice box (larynx) and windpipe (trachea). The swelling narrows the airway just below the vocal cords, and air rushing through that tight spot causes the bark and the noisy breathing.
The American Academy of Pediatrics (AAP) notes that croup is most common between 3 months and 5 years of age. Older kids have wider windpipes, so the same amount of swelling rarely causes trouble. Croup can happen any time of year, but it peaks in fall and winter.
Symptoms of Croup
Croup usually starts like a cold. Over a day or two, you may notice:
- A tight, barking cough
- A hoarse voice or cry
- A harsh, high-pitched sound when your child breathes in (stridor)
- Low-grade fever, though some children run higher temperatures
- Runny nose and congestion
Symptoms are almost always worse at night. According to the AAP, croup typically lasts 5 to 6 days, and the cough itself can hang on for up to two weeks. If you’re unsure whether you’re dealing with croup or something else, it helps to know how a croupy cough differs from a typical cold or flu cough. Once you’ve heard the bark, it’s hard to mistake.
What Stridor Means
Stridor is the raspy sound of air squeezing through a swollen airway. Some children only make it when they’re crying or upset. Any stridor is a reason to call us, and stridor while your child is calm and resting is a sign of more severe croup that needs care right away.
What Causes Croup?
Viruses cause most croup. Parainfluenza viruses are the most common culprit, but RSV, influenza, and other respiratory viruses can cause it too. Like many common childhood respiratory illnesses, it spreads through coughs, sneezes, and shared toys, which is why it moves so quickly through daycares. Antibiotics don’t help, because the cause is viral.
Some children get spasmodic croup, which comes on suddenly at night, often with no fever and few cold symptoms. It’s thought to be related to allergies or reflux, and it can come back.
One important exception: croup-like symptoms that start suddenly after a bee sting, a new medicine, or a food your child is allergic to can signal a serious allergic reaction. Call 911, and review the signs of anaphylaxis in children so you know what to watch for.
How Croup Is Diagnosed
Your pediatrician can usually tell it’s croup by listening to the cough and your child’s breathing and asking about recent cold symptoms. Most kids don’t need any tests. A neck X-ray is sometimes used when croup is severe or slow to improve.
Caring for Croup at Home
Keep Things Calm
Crying makes the cough and the breathing worse. Hold your child, talk softly, read together, or put on a favorite show. Plan to sleep in the same room for a few nights, since stridor can start suddenly while they’re asleep.
Try Warm Mist, Then Cool Air
The AAP symptom checker suggests sitting with your child in a closed bathroom with the hot shower running for about 20 minutes. Keep them well away from the hot water. If that doesn’t help, a few minutes of cold air can: step outside on a cold night, or stand by an open freezer.
Studies haven’t proven that steam or cool air treats croup, but many families find it calms a coughing child, and it’s low risk. Dry air can make croup worse, which matters in Arvada, where heated winter air gets very dry indoors. A humidifier in your child’s room is worth running.
Keep Fluids Going
Offer small sips of water, breast milk, or formula often. Watch for signs of dehydration in children, like fewer wet diapers, a dry mouth, or crying without tears.
Soothe the Cough and Fever Safely
For children 1 year and older, a small spoonful of honey can ease the cough. Never give honey to babies under 1. Acetaminophen can help with fever and discomfort, and ibuprofen is an option for children older than 6 months. If your baby is younger than 12 weeks and has a fever, call us before giving any fever medicine. Skip over-the-counter cough medicines. They aren’t proven to help kids and aren’t approved for children under 6. Keep your child away from cigarette smoke, which makes croup much worse.
How Pediatricians Treat Croup
If your child needs more than home care, the most common treatment is a steroid medicine, usually given by mouth, to reduce swelling in the airway. For more severe croup, a doctor may give a breathing treatment with epinephrine. Children who get epinephrine are watched for 3 to 4 hours afterward to make sure symptoms don’t come back.
If croup keeps coming back, your pediatrician may refer you to an ear, nose, and throat specialist or a lung specialist to look for another cause.
When to Call the Doctor
Call 911 if your child:
- Is struggling for each breath or has loud, constant stridor
- Has bluish lips or face when not coughing
- Passes out or stops breathing
- Is drooling or has great trouble swallowing
- Develops croup symptoms suddenly after a bee sting, a new medicine, or an allergic food
Go to the ER now if your child:
- Has skin pulling in between the ribs with each breath (retractions)
- Is younger than 1 year and has stridor
- May have choked on a small object
Call our office right away if your child:
- Has stridor, even if it’s mild
- Is breathing much faster than normal
- Shows signs of dehydration, such as no urine in 8 hours, a very dry mouth, or no tears
- Has a fever over 104°F, or is younger than 12 weeks with any fever
- Looks or acts very sick
Call us during office hours if your child:
- Is younger than 1 year and has a croupy cough without stridor
- Has had croup 3 or more times
- Still has a barky cough after 14 days
Not sure which group your child falls into? Our online symptom checker can help you sort it out, or you can call our office. When it comes to breathing, it’s always okay to have your child seen.
Can Croup Be Prevented?
Not entirely. The viruses behind croup are everywhere during the cold season. Handwashing and covering coughs help, and so does keeping sick siblings from sharing cups and toys. Staying current on immunizations matters too. The yearly flu shot protects against one of the viruses that causes croup, and the Hib vaccine protects against epiglottitis, a rare but dangerous infection that can look like croup. The same habits cut down on other common winter illnesses.
Final Thoughts
Most croup look and sound worse than they are. A few rough nights, a lot of cuddling, and some steam or cool air usually do the trick. What matters most is knowing which signs mean your child needs help now.
If your child has a barky cough and you’re not sure how serious it is, call Indian Crest Pediatrics at (303) 422-7677. Our team of pediatricians in Arvada sees families from Arvada, Westminster, Broomfield, and nearby, and we’re happy to check your child’s breathing.