Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 9, 2016

Croup is an infection of the upper airway that causes a characteristic cough, often compared to the barking of a seal. Though the sound can be alarming, especially in the infants and young children that are most often affected by croup, the condition is usually not serious. Though croup can occur at any time of year, it's more common during the fall and winter months.


Definition & Facts

Croup develops when the vocal cords, trachea, and bronchial tubes become irritated and swollen. The cough is caused by the sound made when air is pushed through the narrow passages. In addition to the barking sound, breathing with croup causes a whistling sound known as stridor.

Although croup can be scary to parents, it's an incredibly common and typically mild childhood illness. In fact, it affects about 15 percent of children between the ages of six months and five years, and is a common cause of hospitalization among this population. However, serious complications from croup are exceedingly rare.

Symptoms & Complaints

The cough associated with croup typically begins as a common cold. Inflammation increases and leads to the loud, severe coughing, which often becomes worse at night.

A child with croup may also experience fever, hoarseness, and breathing which sounds labored (especially at night). These symptoms, which are exacerbated by the narrow size of the child's airways, usually last three to five days.


Though croup initially manifests with cold symptoms, it's actually commonly caused by the parainfluenza virus, which is spread through airborne particles and surface contact. Most cases of croup occur in children between 6 and 36 months of age, with the peak at about 24 months.

In addition to parainfluenza, measles, adenovirus, and influenza can also cause croup. Keep in mind that many people who come in contact with these viruses manifest only with signs of the common cold and do not develop croup.

Croup is sometimes caused by allergies, breathing in an irritant, or acid reflux; basically anything that causes inflammation in the airways can lead to croup. Croup that is not caused by a virus is called spasmodic croup, a condition similar to asthma. It occurs suddenly at night, is not accompanied by a fever, and frequently recurs.

If your child frequently gets croup that is not related to one of the causes above, there may be another factor causing his or her airways to narrow. An otolaryngologist or pulmonologist can be consulted in these cases to help diagnose the cause of the recurrent symptoms.

Diagnosis & Tests

If croup does not resolve within five days, your child may have a more serious case. Take him or her to the doctor immediately if you notice whistling, labored breathing during both inhale and exhale, exhibits drooling, has difficulty swallowing, breathes more quickly, or develops a blue or grey tinge around the nose, mouth, and fingertips.

If medical treatment is necessary, the doctor will diagnose croup by listening to your child's breathing and examining the throat for signs of inflammation. He or she may attach a pulse oximeter to your child. This device measures whether enough oxygen is reaching the blood.

If necessary, the doctor may use diagnostic tests to rule out other illnesses that manifest with similar symptoms. For example, an X-ray can indicate another cause of blockage in the throat, such as a foreign object, collection of pus, or an inflammation of the epiglottis.

Treatment & Therapy

Most cases of croup can be treated at home using over the counter treatments. Though cold remedies aren't recommended for very young children, fever reducers like Tylenol® can help ease discomfort. One of the most important ways to keep croup from worsening is to keep your child as calm and quiet as possible. Crying can increase throat irritation, exacerbating inflammation.

Try relaxing with your child, rubbing his or her back, singing a favorite song, and offering reassurance. You may also want to sleep in the same room as your child so you can make sure that the condition does not worsen to the point of emergency during the night.

Running a humidifier or giving your child a hot bath may help ease breathing by moistening the airways; you could also try running a cool air vaporizer in your child's room at night. Sitting your child upright in a comfy chair may make breathing easier as well. Keep your child hydrated and feed clear fluids such as water, breast milk, juice, soup, and anything else your child can keep down.

Children who do not want to eat can be hydrated with fruit juice, flavored ice pops, and beverages with crushed ice. Make sure your child gets plenty of rest, even if it is during the day. Croup symptoms tend to get worse at night. No one should ever smoke around your child, but this is especially true if he or she is exhibiting signs of croup.

When symptoms do not resolve on their own, your child's doctor may prescribe a type of steroid that can help keep the airway open. Dexamethasone and epinephrine may also be given to help decrease symptoms like inflammation. In very rare cases, a child with croup may need to be hospitalized and have a windpipe tube placed to ease breathing.

Prevention & Prophylaxis

The best way to prevent croup is by following the same good hygiene you follow to avoid cold and flu. Make sure to wash your hands and wash your child's hands frequently, and disinfect toys and other surfaces daily. Avoid going out in public if you or your child is experiencing symptoms of croup or another infection.

Keeping your child's vaccines current is also critical. Though there is currently no vaccine that prevents the parainfluenza virus, diphtheria and Haemophilus influenza type b vaccines protect your child against the most dangerous upper airway infections.

Children who have a lung disease such as asthma, a neuromuscular disease such as cerebral palsy, or were born prematurely are at a higher risk for complications associated with croup, such as pneumonia and a closed airway. Be especially sure to take steps to prevent croup infection if these risk apply to your child.

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