Croup: Recognizing and Managing the Barking Cough
Croup: Recognizing and Managing the Barking Cough
Croup is a common childhood respiratory condition that causes swelling in the upper airway, resulting in a distinctive barking cough that can sound alarming to parents. While the harsh, seal-like cough can be frightening, especially when it wakes your child in the middle of the night, most cases of croup are mild and can be managed safely at home with simple treatments.
What Is Croup?
Croup is typically caused by a viral infection that leads to inflammation and swelling of the voice box (larynx), windpipe (trachea), and airways leading to the lungs (bronchi). This swelling narrows the airway, creating the characteristic barking cough and breathing sounds. Croup most commonly affects children between 6 months and 3 years of age and is most prevalent during fall and winter months.
The viruses that cause croup include parainfluenza viruses (most common), respiratory syncytial virus (RSV), influenza viruses, and adenoviruses. Croup spreads through respiratory droplets when an infected person coughs or sneezes.
Recognizing Croup Symptoms
Croup often starts like a regular cold with a runny nose, mild cough, and low-grade fever. After 12 to 48 hours, distinctive symptoms develop:
Classic Signs: Harsh, barking cough that sounds like a seal, hoarse or raspy voice, stridor (high-pitched whistling sound when breathing in), difficulty breathing or labored breathing, and symptoms that worsen at night.
Mild Croup: Barking cough only when active or upset, no stridor when calm, normal breathing when quiet, able to eat, drink, and sleep relatively normally.
Moderate to Severe Croup: Stridor even when at rest, chest retractions (skin pulling in between ribs), rapid breathing, nasal flaring, restlessness or extreme fatigue, difficulty swallowing or drooling, and pale or bluish skin around the mouth.
When to Call Your Pediatrician
Parents in Robbinsville, Princeton, and Hamilton should contact our office if your child has: stridor when resting quietly, difficulty breathing that doesn't improve after home treatment, trouble swallowing or excessive drooling, blue or grayish color around the lips, high fever (above 103°F), symptoms lasting more than 3 to 5 days, severe distress or decreased responsiveness, or signs of dehydration.
Seek emergency care immediately if your child has: severe difficulty breathing, cannot speak due to breathing problems, blue or gray skin/lips/nail beds, drooling and unable to swallow saliva, extreme agitation or unusual confusion, or difficulty waking.
Home Treatment for Mild Croup
Steam Treatment: Run a hot shower to create steam in the bathroom. Close the door and sit with your child in the steamy bathroom for 10 to 15 minutes. Keep your child calm by reading or singing quietly. Never leave them unattended around hot water.
Cool Air: Take your child outside in cool night air for 10 to 15 minutes, open the freezer and let your child breathe cool air, or use a cool-mist humidifier in the bedroom.
Comfort and Hydration: Keep your child upright, offer plenty of fluids, use acetaminophen or ibuprofen for fever and discomfort, and create a calm environment.
What NOT to Do: Don't give over-the-counter cough medicines without consulting your pediatrician. Avoid steam with essential oils or menthol, very hot steam that could burn, or exposure to secondhand smoke.
Medical Treatment
If home treatments aren't helping, medical treatment may include corticosteroids (dexamethasone) to reduce airway swelling, nebulized epinephrine for severe cases, or hospitalization for oxygen support and monitoring.
If you have concerns about your child's breathing or croup symptoms, our practice serving families throughout West Windsor, Bordentown, and East Windsor is here to help.
Prevention Strategies
Practice good hand hygiene, avoid close contact with sick people, keep vaccinations up to date (including flu and measles vaccines), maintain a smoke-free environment, and teach children to cough into their elbow.
What to Expect
Croup typically lasts 3 to 5 days, with symptoms often peaking around days 2 to 3. The barking cough may linger for up to a week. Symptoms are almost always worse at night. Your child is contagious during the first few days and should stay home until fever-free for 24 hours.
Frequently Asked Questions
Should I use steam or cool air for croup?
Cool air is most effective for croup. Take your child outside in cool night air or open the freezer and let them breathe the cool air for several minutes. While steam was traditionally recommended, studies show cool air or mist works better and is safer.
When should I seek medical care for croup?
Seek immediate care if your child has difficulty breathing, makes a high-pitched sound when breathing in (stridor) at rest, can't speak or cry due to breathing difficulty, has bluish lips or fingernails, drools excessively, or seems extremely agitated or lethargic.
How long does croup typically last?
Croup symptoms usually peak on the second or third night and typically last 3-5 days. The barking cough may persist for up to a week. If symptoms last longer or worsen, contact your pediatrician.
Is croup contagious?
Yes, the viruses that cause croup are contagious. Keep your child home from school or daycare while they have a fever and severe cough. Practice good hand hygiene to prevent spreading the virus to others.
Will my child need steroids for croup?
Many cases of croup can be managed at home without medication. However, your pediatrician may prescribe oral steroids (like dexamethasone) for moderate to severe cases to reduce airway inflammation and improve breathing. These are very effective and safe when prescribed appropriately.
Need Personal Guidance?
This article provides general information. For questions specific to your child's health, please call our office or book an appointment online.