How to know if a barking cough is croup (and what to do next)

Often characterised by a barking, seal-like cough, croup is one of the most common respiratory conditions for young kids. Here’s what you should know.

Hearing their child struggle with croup can be very frightening for parents – especially if they’ve never heard the tell-tale barking cough before – and it’s very distressing for children.

Despite the harsh, laboured and somewhat disturbing cough, croup is not usually as severe as what it sounds.

“Croup can be a concerning condition, especially when it leads to severe symptoms, but it is not typically considered dangerous when managed appropriately,” InstantScripts Acting Medical Director Dr Hugh O’Sullivan says.

So, what causes croup?

Croup is the swelling of the windpipe and voice box, which causes the airways to become narrower and triggering the characteristic barking cough, whistling sounds when inhaling, and difficulty breathing.

The condition is usually caused by a respiratory virus.

Dr O’Sullivan says croup can be caused by several viruses, some of the more common being:

Croup is most common through the colder months.

“During winter we have multiple viruses circulating,” respiratory epidemiologist Dr Nusrat Homaira explains.

Common symptoms of croup

Croup is recognised by a harsh, barking cough and laboured breathing, accompanied by the symptoms of the infection that triggered it.

“The onset of croup generally starts like any other respiratory infection,” Dr O’Sullivan says. “With mild symptoms like a runny nose, congestion, and fever.”

Croup can often start suddenly and is usually worse at night.

“Symptoms (of croup) generally subside within three to four days, but the cough can persist for almost three weeks,” Dr Homaira says.

Who does croup effect?

Dr O’Sullivan explains croup is seen mostly in children between the ages of six months to three years old, although occasional cases can develop in older kids and adults.

“Croup tends to occur more frequently in children because their airways are smaller and more prone to becoming inflamed and narrowed when affected by a virus,” Dr O’Sullivan says.

Another factor may be that children have a lowered immune response to infections and viruses compared to adults, Dr Homaira says.

In addition, she says children have a higher risk of being exposed to respiratory viruses due to cross-transmission.

“They go to day-care, they go to childcare, and then they go to schools where there is a lot of cross-transmission of respiratory infections,” she says.

How is croup treated?

Exposing your child to cool air may help alleviate symptoms, according to a recent study in children presenting with moderate croup.

Dr O’Sullivan says mild cases of croup often do not need medical treatment.

Instead, parents can provide supportive care at home by:

  • Keeping your child calm, as breathing is often more difficult when upset. “Try sitting quietly, reading a book, or watching TV,” Dr O’Sullivan suggests.
  • Giving paracetamol or ibuprofen if your child has a fever and is irritable.
  • Comforting them. “Croup often becomes worse at night, many children will be more settled if someone stays with them.”

Severe croup symptoms are usually treated by steroids that are taken orally.

Steroids decrease swelling in the airways, allowing easier breathing and less discomfort.

“Children less than one year old or those with pre-existing respiratory or immune system conditions may be at greater risk of experiencing more severe croup symptoms,” Dr O’Sullivan says.

Is croup contagious?

Dr Homaira says the respiratory infections that cause croup are contagious, although not every child who is exposed will develop croup.

“When a child develops symptoms like that, for any respiratory infections, whether it’s upper or lower, try to keep your child at home,” she says.

When to seek help

If croup symptoms become severe it is important to consult a doctor immediately says Dr O’Sullivan.

“It is important to call an ambulance if your child is struggling to breathe, if they become pale or drowsy, and or if they are drooling or struggling to swallow,” Dr O’Sullivan says.

More on childhood health conditions:

Written by Katelin Cameron.