A child who was sleeping well wakes in the night with a harsh, barking cough and a raspy sound when breathing in. This is frightening, yet it is a classic picture of croup, which is often manageable at home when warning signs are checked.
Why It Happens
Croup is usually caused by a virus that makes the voice box and windpipe swell. Children’s airways are narrow, so even slight swelling changes the sound of breathing and coughing. Because it is viral, antibiotics do not help. Symptoms tend to be worse at night.
How It Differs by Age and Stage
Croup is most common between about 6 months and 3 years of age and becomes less common as the airway grows. It often starts like a cold with a runny nose and mild fever, followed by the barking cough, a hoarse voice and noisy breathing in (stridor). The roughest period is usually the first 3-4 days, and most children recover with supportive care. Crying tends to make the noise worse, while calm usually eases it.
What to Do at Home
Keeping the child calm comes first, because crying narrows the airway further. Hold your child upright in a comfortable position. Steamy bathrooms and cold night air are widely used, but evidence for them is limited and hot water carries a burn risk, so use caution. Offer small, frequent sips of fluids and ask the doctor about an age-appropriate fever reducer and dose. A doctor may give a single dose of a steroid such as dexamethasone, which clinical reviews describe as helpful for reducing symptoms.
Common Misunderstandings
Not every barking cough is croup; rarer, more dangerous problems such as a swallowed object or epiglottitis can look similar, and drooling, trouble swallowing or a very ill appearance are clues to tell the doctor. Cough medicine and antibiotics are not expected to speed recovery. Symptoms that improve and then flare up again at night do not necessarily mean the illness has come back, since that up-and-down pattern is typical.
When to Seek Care
See a pediatrician the same day when the barking cough begins. Go to the emergency room right away if the child makes noisy breathing even when calm and resting, the skin sucks in below the neck or ribs with each breath, the child is extremely agitated or unusually limp, the lips or face look blue or gray, or the child drools and cannot swallow. Call emergency services if breathing seems to be failing. This information is based on U.S. and international sources; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.