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Croup

Advice for professionals to be used with parents and carers

What is croup?

Croup (also called laryngotracheobronchitis) can be caused by several viruses which affect the airways including the voice box (larynx), windpipe (trachea) and lungs (the bronchi), causing them to swell and become narrower. It usually affects babies and young children between the ages of one and three years old. Some children have croup two or more times in their childhood.

What are the symptoms of croup?

Your child may have:

  • A cough – the cough is usually harsh and barking. This ‘croupy cough’ is due to inflammation and swelling of the vocal cords in the voice box (larynx)
  • Noisy breathing symptoms – the inflammation can narrow the voice box (larynx) and windpipe (trachea) and cause an extra noise called a stridor. This noise is normally heard on breathing in
  • Breathing may become difficult if the narrowing becomes worse
  • Other symptoms – these may include a runny nose, hoarseness and a sore throat. Croup may follow a cold but can also appear without any earlier illness. Children may also experience a high temperature (fever), general aches and pains and be off their food
  • The symptoms of croup appear worse at night. They usually peak after one to three days and then improve. A mild but irritating cough may persist for a further week or so.
Paediatric pathway

To see the croup paediatric pathway click here.

When should you worry?

If your child has any of the following:

  • Is going blue around the lips
  • A harsh breath noise as they breathe in (stridor) present all of the time (even when they are not upset)
  • Has pauses in their breathing (apnoeas) or has an irregular breathing pattern
  • Is too breathless to talk, eat or drink
  • Becomes pale, mottled and feels abnormally cold to touch
  • Becomes extremely agitated (crying inconsolably despite distraction), confused or very drowsy (difficult to wake)
  • Develops a rash that does not disappear with pressure (the ‘Glass Test’)
  • Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features). 

You need urgent help

Go to the nearest hospital emergency (A&E) department or phone 999

If your child has any of the following:

  • Has laboured/rapid breathing or they are working hard to breathe – drawing in of the muscles below their lower ribs, at their neck or between their ribs
  • A harsh breath noise when they breathe in (stridor) present only when they are upset
  • Seems dehydrated (sunken eyes, drowsy or no urine passed for 12 hours)
  • Is becoming drowsy (excessively sleepy)
  • Drooling and has difficulty swallowing saliva
  • Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations)
  • Seems to be getting worse or if you are worried.

You need to contact your GP surgery today

Please ring your GP surgery or contact NHS 111 - dial 111 or for children aged 5 years and above visit 111.nhs.uk

If none of the features in the red or amber boxes above are present

Pharmacy/self-care

Pharmacists can advise and treat a range of common symptoms. No appointment is needed and most pharmacies have a private consulting area. Click on this link to find a pharmacy near to you

If you are still concerned about your child, contact NHS 111 – dial 111 or for children aged 5 years and above visit 111.nhs.uk

This guidance has been reviewed and adapted by healthcare professionals across the Black Country Integrated Care System.

How can I help my child?
  • Stay calm in order to reassure your child – children with croup may become distressed and crying may make their symptoms worse
  • Sit your child upright on your lap if their breathing is noisy or difficult. Let them find the most comfortable position
  • Encourage your child to drink cool drinks regularly (little and often) to help soothe their throat and keep them hydrated
  • Give your child paracetamol or ibuprofen liquid, following the instructions on the bottle
  • If their temperature is high, dress them in cool, loose clothes (if any) and don’t use anything warmer than a sheet to cover them in bed
  • Stay with your child, or check him or her regularly, as you need to know if the symptoms are getting worse
  • Some people find that taking their child outside in the cool, fresh air helps to relieve their symptoms.
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