Croup Symptoms in Children

Learn the difference between a regular cough and a croup cough

young girl coughing in bed

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Croup is a viral infection in children that causes swelling in the trachea (windpipe) and larynx (voice box). It's quite common and scary for both kids and parents. Luckily, it's usually not serious.

Like some other childhood viral infections—such as roseola, which causes a fever followed by a rash, or fifth disease, which causes a bright-red rash on the cheeks—croup has distinctive symptoms and is generally easy to recognize. There's no formal test for croup. Your child's pediatrician will most likely diagnose it based on the presence of certain telltale symptoms. 

Symptoms of Croup

Children with croup are usually about 6 months to 6 years old, have a few days of low-grade fever, cough, runny nose, and then suddenly—typically in the middle of the night—develop:

  • A bark-like cough
  • A hoarse or raspy voice
  • Difficulty breathing and inspiratory stridor: This harsh, loud, high-pitched noise that kids with croup can make when they take a breath may be confused with wheezing.
  • Continued fever, which can be low-grade or up to 104 degrees Fahrenheit, although some kids with croup don't have any fever at all

If your child has croup, the symptoms are likely to be worse at night, when they're agitated and better during the day, when they calm down. Symptoms can also get better when your child is exposed to cool air, which explains why many children get better on the way to the emergency room.

Severity of Croup

Most cases of croup are mild and go away when treated with home remedies. However, depending on how difficult it is for them to pull air into their lungs, some children have more severe symptoms and need immediate medical attention. Here's what you need to know:

Mild Croup: Kids with mild croup are alert and don't have a bluish discoloration of their skin or nails (cyanosis), which means their blood is supplying enough oxygen. They also don't have retractions, which is sucking in of the skin around the ribs and the top of the sternum (breast bone). They may have a barking cough. Stridor isn't present when they're resting but it may occur as they cough or cry. Mild croup can become more severe intermittently throughout the course of the illness, especially during the evening hours.

Moderate Croup: Children with moderate croup may have stridor and retractions at rest, may be slightly disoriented or agitated and may have moderate difficulty breathing.

Severe Croup: Retractions are a sign of severe croup, and a child with severe croup has stridor and retractions at rest. These include an inward movement of the sternum or skin between the ribs as the child struggles to take a breath. He or she may appear anxious, agitated, or fatigued. Cyanosis is common when the child is moving or crying, but then progressively worsens and becomes noticeable even when the child is resting.

How to Distinguish Between a Cough and Croup

Croup produces a very distinct cough, said to sound like a barking seal. If you're not sure what that sounds like, you can search for "croup cough" videos on YouTube to get a better idea. A croupy cough sounds much different than any another cough your child will have with a cold, asthma, or bronchitis.

The distinctive cough occurs as the infection progresses from the nose and throat to the windpipe, and the space available for air to enter the lungs narrows.

If you suspect your child may have croup—especially if you think your child may have severe croup symptoms—call your child's pediatrician right away. Your child's doctor can help diagnose croup and figure out the best way to treat the condition so your little one can feel better fast. 

Treatment for Croup

If your child has croup, your doctor may prescribe a steroid to help reduce any inflammation in his or her airway. A child with a severe infection may need to be hospitalized.

At home, you can make your child more comfortable by setting up a humidifier or sitting him in a bathroom (not in the shower) filled with steam generated by running water from the shower. If they're agitated, try and remain calm as to better help them relax—anxiety can worsen symptoms. Fluids and fever reducers can help manage symptoms as well.

There are various home remedies that can help your child get over croup. But if you're concerned your child's infection is not clearing up, don't hesitate to call your doctor.

Tips for Preventing Croup

Croup is caused by a virus, so it can spread through coughing and sneezing as well as by dirty hands, sharing toys, and sharing drinking glasses or utensils. To help prevent croup, the American Academy of Family Physicians recommends that you:

  • Make sure everyone in your house washes their hands often.
  • Throw away dirty tissues from runny noses and sneezes right away.
  • Wash toys in hot soapy water if a sick child has had them in his or her mouth.
  • Ask people with a cough to avoid kissing or playing with your child.
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