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Croup in babies

Croup in babies and children causes a very distinctive, barky-sounding cough that's typically worse at night. Most cases are mild and get better on their own within a few days, but serious cases require medical treatment. 

Baby in bed with croup
Photo credit: © Protonic Ltd / Stocksy United

What is croup?

Croup is a swelling of the voice box (larynx) and windpipe (trachea), usually caused by a virus. Telltale signs of croup are a cough that sounds like a barking seal, a hoarse voice, and a high-pitched squawking or whistling sound (called stridor) when your child breathes in.

Croup is most common in children between the ages of 6 months and 3 years, although a child can get croup at any age. (As the windpipe grows, swelling is less likely to constrict breathing.) The illness shows up most frequently in the fall and early winter, and it's slightly more common in boys than girls.

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Croup can be very mild or severe. Most children recover quickly within days, but a severe case can require hospitalization.

What causes croup?

Viral croup. The most common type of croup is caused by a viral infection in the voice box and windpipe. The two main culprits are the human parainfluenza virus (HPIV) and influenza (flu) virus, though other viruses (such as respiratory syncytial virus, adenovirus, rhinovirus, and enterovirus) can also trigger croup. We're still learning about COVID-19, but there are recent reports of children with the COVID-19 virus developing croup.

The viral infection is spread through the air and by touching people or surfaces with the viruses on them and then touching your mouth, nose, or eyes.

Spasmodic croup. An allergy, reflux, or inhaled irritant (such as smoke) can cause spasmodic croup. If your child has spasmodic croup, they may wake in the middle of the night with a hoarse voice and stridor. Spasmodic croup usually gets better with allergy or reflux medications.

A bacterial infection can also cause croup, though it's uncommon.

Croup symptoms

If your child has viral croup, they may first have cold symptoms and then develop a distinctive cough. (Spasmodic croup occurs without cold symptoms.)

Common symptoms of croup are:

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  • A barking cough. Because croup swells the throat and voice box, it alters the sound of your child's cough. If your child has a very hoarse, deep cough that sounds like a barking seal, it's probably croup. In fact, this cough is so distinctive that your doctor can probably tell you whether it's croup just by listening to your child over the phone.
  • Noisy breathing. Your child may have labored breathing or stridor.
  • Hoarse voice
  • Fever (viral croup, not usually spasmodic croup)

Croup symptoms commonly get worse at night and are often worst the first couple of nights. Symptoms usually subside in 3 to 5 days, though it may take a week.

Your child may also develop conjunctivitis, a rash, and/or swollen lymph nodes, depending on the virus causing the illness.

Unless your child's croup is the result of allergies or reflux, the virus that's causing it is contagious, so keep them home until they're free of symptoms.

Croup vs. COVID

Croup and COVID aren't mutually exclusive. In other words, the COVID-19 virus can cause croup the same way that other viruses (most often the influenza or parainfluenza viruses) can.

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Of course, your child can have COVID that doesn't develop into croup – or croup that has nothing to do with COVID. Croup usually starts with cold symptoms that are similar to the symptoms of COVID, and both croup and COVID can share the symptoms of a fever and cough. But a croupy cough will have that distinctive, barky sound, while a COVID cough will sound more like the cough accompanying a cold (though perhaps less mild). Also, if your child has other symptoms, such as a headache, stomach ache, or body aches, then it's more likely they have another illness (such as COVID or the flu).

The sound of the cough can probably tell you if your child has croup, but the only way to know for sure if your child has COVID is to have them tested.

Learn how to tell if your child has a cold or COVID-19.

When should I call the doctor?

Most children with croup have only mild symptoms and don't need to see a doctor, although it's always a good idea to call if you have concerns.

While the vaccines for measles, Haemophilus influenzae (Hib), and diphtheria protect children against some of the more dangerous forms of croup, severe cases do still occur, causing serious, potentially life-threatening swelling in the throat.

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Call 9-1-1 for an ambulance if your child:
  • Turns blue or very pale. You may first notice blue-tinged skin in the fingers, ear lobes, tip of the nose, lips, tongue, and inside of the cheek. This can happen as airflow to the lungs is restricted.
  • Is struggling to breath.
  • Can't speak or cry because they can't breathe.
  • Seems very sleepy or unresponsive.
  • Makes a whistling sound (stridor) that gets louder with each breath both inhaling and exhaling.
  • Has extreme difficulty swallowing saliva, is drooling.

Read more about when to call 911.

Call your child's provider if:

  • Your child has stridor when resting.
  • Your child's cough or other croup symptoms continue more than a few days.
  • Your baby is younger than 3 months and has a fever.
  • Your child is older than 3 months and has a fever over 100.4 degrees F.
  • The skin and muscles between or below your child's ribs look like they're caving in.

How do you treat croup?

Home remedies for croup

If this is your child's first bout of croup and the doctor determines that your child has a mild case, you should be able to treat them at home. Here are some tips for keeping your child comfortable:

  • Comfort your child. Give your child a hug or a back rub. Reassure them everything will be OK, sing a favorite bedtime song, and/or offer a favorite toy. Crying and agitation can make croup worse, but if you can keep your child calm they're likely to breathe more easily.
  • Keep your child hydrated. Make sure your child is getting plenty of fluids. It may be difficult for them to swallow, making dehydration more likely. Breastfeed or formula feed your baby often. Offer your child ice pops made of fruit juice, or give them sips of water from a spoon if they refuse to drink from a cup.
  • Elevate their head. If your child is more than a year old, you can try elevating their head a bit while they sleep, to help ease their cough. (Don't use pillows with babies, as this increases the risk of SIDS.) You may also want to sleep in the same room with your child while they have croup, so you'll notice whether they develop any trouble breathing.
  • Take your child into a steamy bathroom. Moist air may help reduce swelling of the airways, although there aren't scientific studies to prove it. Turn on the hot water in the shower or bathtub and close the bathroom door. Sitting straight up or standing will help her breathe more easily. If your child is too young to sit up straight or stand, try holding them upright. You may have to repeat the routine each time your child wakes up coughing during the night.
  • Go out into the cold night air for 15 to 20 minutes. Again, this isn't scientifically proven, but some parents find this helps their child breathe better. You can also just open the window for a few minutes. Wrap your child in a blanket to keep them warm.
  • Put a humidifier in your child's bedroom. Use a cool-mist humidifier, not a hot, steam-based one as this could put your child at risk for burns. (Clean the humidifier daily with a bleach-and-water solution to ward off the growth of mold and bacteria.)
  • Give your older baby or child warm, clear fluids, such as warm water or broth. This can help loosen mucus on the vocal cords
  • Keep your child away from smoke. Don't let anyone smoke in your home. This can make your child's cough worse.
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Medications for croup

While antibiotics aren't usually used to treat croup (because it's not typically caused by bacteria), there are other medications that may help your child. These include:

  • Over-the-counter painkillers: If your child has a fever and is uncomfortable, you might want to give them acetaminophen or, if they're 6 months or older, ibuprofen. (Never give a child aspirin, which can trigger a rare but potentially fatal disease called Reye's syndrome in children with a virus.) If your child is younger than 3 months old, talk with their doctor before giving them any medication, even over-the-counter remedies.
  • Steroids. These are sometimes prescribed by a doctor to reduce the swelling and help your child breathe more easily. If your child is unable to take an oral steroid (because they spit it out or their breathing is too labored to swallow it), they may be given an injection instead.
  • Epinephrine, oxygen and intravenous fluids. If your child has a severe case of croup, they may be given oxygen, an inhaled medication, or steroids to help reduce the swelling of their airways. They may require hospitalization and intravenous fluids to combat dehydration.

Do not give your child cough medicine. It won't have any effect on the swelling in his throat, and it can make it harder for him to cough up mucus.

Can my child get croup again?

Yes. In fact, some children seem to be more prone to getting croup than others until their airways grow bigger. If your child gets croup a second time, try the at-home therapy right away. And don't hesitate to call your doctor, even if the previous episode was mild. Each bout of croup is different – some more serious or needing more aggressive treatment than others.

If your child continues to get croup – more than twice a year – they have what's called recurrent croup. Your child's doctor will want to evaluate your child for other conditions that may be causing the repeated croup, such as asthma, or for abnormalities in the throat or airway. (The abnormality might be something your child was born with or something that resulted from an injury or that they developed later.) Your child's doctor may refer you to a specialist, such as an otolaryngologist (ear, nose, and throat doctor) or a pulmonologist (breathing and lung specialist).

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How can I prevent my child from getting croup?

You can reduce your child's chances of getting croup by:

  • Frequent hand washing with soap and water.
  • Keeping your child away from anyone who has a respiratory infection.
  • Making sure your child gets vaccinated every year against the flu if she is older than 6 months. (The flu vaccine won't protect your child from HPIV infections, only against influenza.)
  • Make sure your child has received their Hib vaccine, to help protect against serious respiratory infection.

Keeping your baby or child from getting croup – or any number of illnesses – may feel like a tall order, especially in the months when respiratory infections peak. Check out our article on how to keep your baby healthy this winter for some more tips.

Learn more:

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

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Karen Miles
Karen Miles is a writer and an expert on pregnancy and parenting who has contributed to BabyCenter for more than 20 years. She's passionate about bringing up-to-date, useful information to parents so they can make good decisions for their families. Her favorite gig of all is being "Mama Karen" to four grown children and "Nana" to nine grandkids.
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