Croup

Croup is a viral illness in babies and young children that causes a narrowing of the upper airways, often leading to a 'barking' cough (like a seal), hoarse voice and raspy breath.

COVID-19 pandemic

If you have any respiratory symptoms such as a cough, sore throat, shortness of breath, head cold or loss of smell, with or without fever, stay at home and call your GP or Healthline's dedicated COVID-19 number 0800 358 5453 to check whether you need to be tested for COVID-19.

Key points about croup

  1. Croup is a viral illness that causes narrowing of the upper airways.
  2. Croup is often worse at night.
  3. Croup is often a mild illness but can quickly become serious, so do not wait to get medical help.
  4. There is effective treatment for severe episodes of croup.
  5. Steam doesn’t help and may lead to accidental burns – don't use it.
Call an ambulance 111 for emergency help if your child:
  • has blue or dusky coloured lips (may occur after a coughing spell)
  • is not breathing continuously
  • is having extreme difficulty breathing
  • seems confused or drowsy.
See a doctor urgently if your child has any of the following symptoms:
  • has stridor (a harsh noise heard when breathing in) when they are calm and not upset
  • starts dribbling or cannot swallow
  • cannot bend their neck forward
  • is not having enough fluid
  • has a high temperature
  • develops earache
  • is having difficulty breathing
  • you are concerned that your child is getting worse.

For further information and support talk to your doctor or practice nurse. You can also phone Healthline on 0800 611 116 for advice.

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What is croup? 

Croup is a viral illness in young children, which causes narrowing of the upper airways. Some children have recurring croup and this may need further assessment. 

How does croup develop?

When you breathe, air passes through the voice box (larynx) and windpipe (trachea) into the lungs. In croup, a viral infection causes inflammation and swelling of the lining of the voice box and windpipe, which become narrowed. When the airway becomes narrowed, breathing in becomes more difficult, and you can hear stridor (a harsh noise when breathing in).

Who gets croup?

Babies and children 6 months to 3 years are at most risk of getting croup, but children who are younger or older can also get it. As children grow, their windpipe strengthens, lessening their chance of getting croup. It is common in the autumn and spring. 

Croup is usually caused by a viral infection. If your child has repeated occurrences of croup (more than 1 per year), or is under the age of 6 months or over the age of 6 years and gets croup, you should contact your doctor. Your doctor may arrange further investigation or refer you to a specialist to see if there is another cause. 

What are the symptoms of croup?

Croup often starts like a common cold with a slight fever, red eyes, sore throat and runny nose.

  • After a few days, other symptoms develop including a barking, seal-like cough and raspy noise when they breathe in (stridor).
  • Symptoms are almost always worse at night and crying generally makes the barking cough and noisy breathing worse.
  • Croup is usually worse on the 2nd or 3rd night and can last up to a week, though the cough can last longer. As the child gets better, the cough will usually become looser.
  • Croup is contagious for about 4 to 6 days and is spread by droplets in the air from coughs and sneezes.

Some children can have a form of croup that comes on quickly, often at night, but also resolves after about an hour or so. These children may be more likely to already have asthma or to develop asthma.

How is croup treated?

The treatment of croup depends on how severe the illness is. Because croup is caused by a virus, a mild case will usually clear up on its own. You can use simple self-care measures such as those listed in the table below to keep your child comfortable. Moderate to severe cases need observation in hospital, often overnight. 

Simple measures to keep your child comfortable

Keep your child calm and comfortable Try to keep your child calm with cuddles and reassurance. Children are often more comfortable in the upright position. Sit toddlers and small children up with pillows. Babies may rest more comfortably in their car seat or stroller in the upright position.
Stay with your child when coughing Croup can be frightening for the parent and the child. Stay with your child all the time when they are coughing. Handle him or her gently, and talk quietly and firmly. The symptoms of croup will be worse if the child is upset and feels that you are not in control.
Keep your child hydrated Encourage your child to drink small sips of fluids regularly, to help soothe their throat and keep them hydrated.
 Give simple pain relief  You can give your child simple pain relief such as paracetamol if your has a fever or a sore throat. Follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.

What not to do

  • Don't use steam. It can be dangerous for your child because of the possibility of burns or scalding.
  • Don't put anything in your child's mouth to look at their throat. This may make symptoms worse.
  • Do not give your child cough medicines. These will dry the mucus, making the airways even smaller.

What medicines are used to treat croup?

  • Paracetamol can be given if your child has a fever or a sore throat.
  • Sometimes steroids (prednisolone) taken by mouth are given for croup. The steroids help reduce the swelling in the airways and this will make breathing easier.
  • If the croup is very severe, your child may be given nebulised adrenaline which reduces the airway swelling and makes breathing easier.
  • Antibiotics are not used to treat croup unless your child develops a bacterial infection as well. This can be diagnosed by your doctor.

Learn more

The following links provide further information about croup. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Croup KidsHealth NZ
Croup Asthma + Respiratory Foundation NZ
Croup Ministry of Health, NZ

Reviewed by

Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. She is looking forward to further study with Otago University in public health to learn about how we can reduce preventable disease and inequalities.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Alice Miller, FRNZCGP Last reviewed: 12 Jan 2021