Croup is a condition caused by an upper viral respiratory infection in young children. In most children it is very similar to the common cold, but can be a more serious illness in children younger than 4 years old. It is usually characterized by a distinctive cough (“barking cough”) with stridor, and hoarseness or laryngitis. In older children and adults it is more like a typical cold with some hoarseness or laryngitis.

Croup is more commonly encountered in late fall and winter months. Since croup is a viral illness, antibiotics cannot be used to treat it.


  • Runny nose and congestion
  • Fever
  • Dry, harsh cough that sounds like a seal barking.
  • Hoarseness
  • Stridor (a harsh low-pitched sound when the child is breathing in).


Croup is an upper respiratory infection in which is caused mainly by the para-influenza virus. It can also be caused by the influenza virus, which also causes the flu, and other respiratory viruses. Some children are more prone to croup than others, with frequent croup symptoms whenever the child has a cold. This may be due to the nature of the child’s airway. Whatever the reason, children almost always outgrow it by the age of 5 or 6 years.

Clinical course

Croup starts off as a normal cold, with clear runny nose, nasal congestion and mild cough. There is often a fever, and sometimes the child complains of a sore throat. Two to four days after the runny nose starts, a cough develops, like with many colds. However, in this case the cough is dry and harsh sounding. It has a distinctive sound described like a seal barking. The cough is almost always worse at night. The child usually has a hoarse voice as well. At night, the child often has stridor with agitation or crying. Children often have episodes of cough and stridor followed by relief of symptoms. Episodes usually occur 1-2 nights in a row and then croup symptoms start to get better.

The danger of croup is that the airway can become so narrow that breathing becomes labored or impossible. Warning signs are stridor at rest, drooling, or labored breathing. Moderate to severe croup will generally require a trip to the doctor’s office or emergency room. More seriously ill children require observation and treatment in the hospital. The routine use of steroids has decreased the frequency of severe croup and hospital admission. Runny nose and congestion can last 7-10 days, along with some cough. The barking cough and stridor episodes typically are at their worst on the 3rd and 4th day after the onset of symptoms before getting better.


  • Exposure to water vapor. Take the child into the bathroom and run hot water to steam up the room and let the child breathe the steam. Try to keep your child calm.
  • Exposure to the cool night air or letting the child breathe air in front of your freezer. If you have a humidifier (not a hot vaporizer), you can let your child breathe the mist from it.
  • If your child worsens or does not improve after 15-20 minutes, then she may need to be evaluated at an emergency room. If your child turns blue, passes out, or has extreme difficulty breathing, call 911.

General treatment

  • Steroids are the standard treatment for croup. Steroids have been shown to prevent mild croup from becoming severe.
  • Acetaminophen or ibuprofen can be given for fever or discomfort.
  • Cough and cold medicines are not usually helpful.
  • Warm, clear fluids can help with congestion and sometimes cough.
  • Using a humidifier may help.
  • Most young children who are ill have decreased appetite. It is generally OK if your child does not eat much, as long as she has adequate fluid intake. Adequate fluid intake in a young child means being able to make some urine at least every 6-8 hours.
  • Children with croup require close observation. Since symptoms are worse at night, many parents feel more comfortable sleeping in the same room with their child when the symptoms are at their worst.
  • Because it is a viral infection, antibiotics are not useful in treating croup.


Complications are similar to other respiratory viruses and include otitis media (ear infections), sinusitis, and pneumonia. Severe croup, as noted, may lead to breathing difficulties or respiratory arrest.


Hand-washing and good general hygiene. Croup viruses are spread through respiratory secretions.

Keep children who have croup at home until they have sufficiently recovered. This will afford them the rest they need to recover, and also prevent the exposure of other children.

Return to daycare or school

Croup is contagious, but like other viral illnesses the spread of the infection is almost impossible to prevent.

Children should stay home while she has a fever and while she has significant cough.

Your child can return to daycare or school when she feels better and is drinking well.

If you have any further questions or concerns, please call your Pediatrician, or contact our office.