When your child wakes suddenly with a harsh, barking cough and noisy breathing, the word croup can start circling in your mind. Is it dangerous? Will it pass? Should you head out in the night? Croup is usually viral and short-lived, yet it can look dramatic—especially when swelling sits just below the vocal cords and every breath sounds louder than it “should.” Knowing what croup is, how severity is judged, what helps at home, and which signs call for urgent care can steady your next steps.
What croup is and why the cough sounds “barky”
Croup is an upper-airway illness most often caused by viruses. The infection inflames the larynx (voice box) and the top part of the trachea (windpipe). In small children, that airway is naturally narrow, add swelling in the subglottic area (just under the vocal cords), and air starts squeezing through a tighter space.
That’s why croup has its signature sounds:
- A barking, seal-like cough
- A hoarse voice (inflamed vocal cords vibrate differently)
- Inspiratory stridor (a high-pitched sound when breathing in)
Stridor only when crying is often milder, stridor at rest deserves faster medical assessment.
Who gets croup most often (and when)
Croup peaks between about 6 months and 3 years. After that, episodes tend to fade because the airway grows wider. Many families notice clusters in fall and early winter, in step with seasonal respiratory viruses.
Nighttime is often the hardest. Cortisol dips overnight, fatigue lowers coping reserves, and dry air can irritate swollen tissue—so croup may sound much worse after bedtime.
Types of croup: viral, spasmodic, and “atypical” patterns
Most croup follows a predictable sequence:
- Runny nose, sneezing, mild fever—like a standard cold
- After 12–48 hours: barking cough, hoarseness
- Nights 1–2 often feel the roughest, symptoms then settle
The bark often improves within about 48 hours, even if a regular cough lingers. Total duration is commonly 3–7 days.
Spasmodic croup (sudden nighttime attacks)
Spasmodic croup can appear out of nowhere at night. Some children seem fine during the day, then wake up with barking cough and stridor, often with little or no fever.
Possible triggers discussed in clinic include smoke or strong fumes, reflux symptoms (gastroesophageal reflux, GERD), and an atopic tendency (allergies, eczema).
Recurrent or atypical croup: when to look deeper
A closer medical look is often considered when croup happens repeatedly, is unusually severe, occurs outside the usual age range (under 6 months or older than ~5–6 years), or doesn’t respond as expected.
Sometimes the airway is simply narrower (for example subglottic stenosis), or there are contributing irritants, reflux, or allergic inflammation.
Croup symptoms: what parents typically notice
Most families recognize croup through a combination:
- Barking cough
- Hoarse, raspy voice
- Stridor (especially at night)
You might also see faster breathing or visible effort—skin pulling in between ribs (intercostal retractions) or at the base of the neck.
Breathing effort and stridor: practical red flags
Stridor tells you air is meeting resistance. The key question: when does it happen?
- Only with crying or agitation: often mild
- At rest: needs prompt assessment
Watch for increased work of breathing: retractions, flaring nostrils, rapid breathing, agitation—or a worrying shift to unusual sleepiness/exhaustion.
Fever, fatigue, and drinking
Croup may come with fever, but fever isn’t required. What often matters more is function: drinking less, feeding becoming tiring, fewer wet diapers.
Babies vs toddlers vs older children
- Babies (especially under 12 months): smaller airway, symptoms can progress quicker, and feeding can deteriorate fast.
- Toddlers (1–3 years): classic age for croup, nighttime worsening is common.
- Older children: croup is less likely, clinicians think more about alternative diagnoses.
Causes of croup and how it spreads
Croup is usually viral. Common viruses include parainfluenza (types 1–3), RSV, influenza A/B, adenovirus, rhinovirus, human metapneumovirus, and SARS‑CoV‑2.
When bacteria enter the conversation
Typical croup is not bacterial. However, high fever, a very ill appearance, thick secretions, and worsening breathing can point toward bacterial tracheitis. In under-immunized settings, diphtheria is a rare consideration.
Everyday factors that can worsen croup symptoms
The airway can become more reactive with smoke exposure (including third-hand smoke on clothes), strong scents or sprays, very dry air, reflux/GERD, and atopy (allergies, eczema).
Contagiousness
Yes—children spread the viruses behind croup through droplets and hands/surfaces. Many are most contagious in the first few days, and daycare policies often rely on being fever-free for 24 hours (without fever medicine) plus being well enough to participate.
Is it croup or something else?
- Common cold: cough, runny nose, not typically barking.
- Bronchiolitis: lower-airway disease with wheeze/crackles and feeding difficulty, usually no stridor.
- Asthma/wheezing: noise mainly when breathing out, stridor points higher up.
More serious look-alikes
- Epiglottitis: high fever, drooling, difficulty swallowing, muffled voice, very unwell child—emergency.
- Bacterial tracheitis: toxic appearance, high fever, stridor that doesn’t improve as expected.
Foreign body aspiration
A sudden onset during eating or play, without fever, can suggest inhalation of a small object. Any suspicion needs urgent assessment.
How clinicians judge croup severity
- Mild: barking cough, stridor only when upset, minimal retractions.
- Moderate: stridor may occur at rest, clear retractions, distress but alert.
- Severe: prominent stridor at rest, marked retractions, very fast breathing, agitation or exhaustion.
Signs clinicians worry about
Seek emergency help if you see increasing drowsiness/poor responsiveness, poor air movement (breathing sounds becoming quieter), blue/gray lips or face (cyanosis), or pauses in breathing.
Westley croup score
Some teams use the Westley croup score (alertness, cyanosis, stridor, air entry, retractions) to track severity and guide decisions such as nebulized epinephrine and observation.
When to seek medical care for croup
Home care can be reasonable when croup looks like barking cough with comfortable breathing between coughs, no stridor at rest, good drinking/urination, normal skin color, and good alertness.
Same-day medical advice
Call a clinician the same day if your child is very young (especially under 3 months), has stridor at rest, increasing retractions/rapid breathing/nasal flaring, high or persistent fever, reduced drinking, fewer wet diapers, or symptoms not improving over 3–5 days.
Emergency signs
Go to the ER / call emergency services if there is stridor at rest with obvious breathing difficulty, blue/gray color, pauses in breathing, extreme tiredness, inability to drink, signs of dehydration, or rapid worsening.
Drooling + refusing to swallow
Drooling with trouble swallowing, muffled voice, and high fever is a major red flag (possible epiglottitis). Avoid inspecting the throat at home, seek emergency care immediately.
How croup is diagnosed
Diagnosis of croup is usually clinical: listening for stridor, noting hoarseness and the barking cough, counting respiratory rate, and checking retractions. Pulse oximetry may be used to check oxygen saturation.
A neck X-ray is reserved for unclear or severe cases, it may show subglottic narrowing (“steeple sign”). ENT or pediatric pulmonology review may be discussed for recurrent, severe, atypical croup, or stridor between illnesses.
Medical treatment for croup
Steroids reduce upper-airway inflammation and are the backbone of croup treatment.
- Dexamethasone is often given as a single dose (commonly 0.6 mg/kg, max 10 mg) by mouth or injection.
- Prednisolone may be used in some settings.
- Nebulized budesonide is an option when oral medicine is difficult.
Nebulized epinephrine and observation
For moderate to severe croup, nebulized epinephrine can rapidly reduce swelling and improve stridor. Because the effect is temporary, children are monitored afterward to watch for symptom return.
Hospital care and antibiotics
Severe croup may require oxygen and close monitoring, rarely heliox or intubation is needed. Antibiotics do not help viral croup and are reserved for suspected bacterial infection (for example bacterial tracheitis).
Home care for mild croup
Crying tightens the upper airway and can amplify stridor. Hold your child upright, keep your voice steady, dim the room, and aim for slow breathing together.
Fluids, rest, and positioning
Offer frequent small drinks. If feeding is hard, smaller and more frequent feeds can be easier.
Upright positioning often helps. For sleep, keep the sleep space safe and flat, avoid propping with pillows. If your baby struggles lying down, holding them upright for a period can help while staying awake and alert.
For fever or throat pain, acetaminophen/paracetamol or ibuprofen can be used when appropriate for age and health history. Avoid aspirin in children.
Humidity and air: what to try safely
Evidence for humidified air is mixed, yet some children seem to feel better with cool mist.
- Use a cool-mist humidifier
- Clean it daily to limit mold/bacteria
- Keep it out of reach
Avoid hot steam (burn risk) and essential oils that may irritate the airway.
What to avoid
Avoid over-the-counter cough syrups and sedating medicines unless prescribed.
How long croup lasts and what recovery looks like
Many children improve in 3–5 days and are much better within a week. Seek advice if symptoms worsen, drinking drops, breathing becomes harder, or croup persists beyond about 3–5 days without improvement.
Recurrent croup and higher-risk situations
Repeated croup can relate to reflux/GERD, atopy, irritants, or a narrower airway. ENT tests (flexible laryngoscopy/bronchoscopy) may be suggested when episodes are frequent, severe, outside the usual age range, or when stridor persists between illnesses.
Infants under 6 months and children with chronic lung disease, neuromuscular conditions, immunosuppression, or prior airway problems often need earlier assessment.
Croup in adults
Adults can get a croup-like illness, but it’s uncommon. Because adult stridor is unusual, stridor at rest, rapid worsening, drooling, swallowing difficulty, allergic swelling, or low oxygen should be treated as urgent.
Key takeaways
- Croup often starts like a cold, then turns into a barking cough with hoarseness and sometimes stridor—often worse at night.
- Stridor at rest and increasing work of breathing (retractions, nasal flaring) call for prompt medical assessment.
- Emergency signs include blue/gray color, pauses in breathing, extreme tiredness, drooling with trouble swallowing, and inability to drink.
- A single dose of dexamethasone is a common medical treatment, nebulized epinephrine may be used for more significant breathing difficulty with observation afterward.
- Most croup is viral and improves within days, calm, upright positioning and good hydration help.
- Recurrent or atypical croup may relate to reflux, atopy, irritants, or airway differences.
- Resources and health professionals can support you, you can also download the Heloa app for personalized tips and free child health questionnaires.
Questions Parents Ask
Can cold air help croup at night?
Sometimes, yes. A few minutes of cool night air (or standing by an open window while keeping your child warmly dressed) can temporarily ease noisy breathing for some children. If it seems to help, you can repeat briefly and focus on keeping your child calm and upright. If stridor happens at rest, breathing looks hard, or your child seems very tired, it’s important to seek urgent medical advice rather than relying on home measures.
Is honey OK for a croup cough?
For children over 1 year, a small amount of honey can soothe an irritated throat and may calm coughing. For babies under 1 year, honey isn’t recommended due to the risk of infant botulism. If you’re unsure what’s appropriate for your child’s age or health history, you can check with a clinician—no guilt, these details are easy to miss when you’re sleep-deprived.
Why does my child keep getting croup?
Recurrent episodes can happen, and it’s often not a sign you’ve done anything wrong. Some children simply have more reactive airways, and triggers like viral infections, reflux, smoke exposure, or allergies can contribute. It’s worth discussing with a healthcare professional if episodes are frequent, unusually severe, outside the typical age range, or if your child has noisy breathing even when they aren’t sick—there are evaluations and options that can help.
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