Croup is a common respiratory condition that affects children, especially between 6 months and 5 years of age. It is characterized by a distinct barking cough, hoarseness, and noisy breathing due to inflammation of the upper airways, particularly the larynx (voice box) and trachea (windpipe). While the condition can be alarming for parents, most cases are mild and can be treated at home.

Causes

Croup is primarily caused by viral infections, most commonly the parainfluenza virus. Other viruses that may lead to croup include influenza A and B, respiratory syncytial virus (RSV), adenovirus, and rhinovirus.

The infection causes swelling around the vocal cords, windpipe, and bronchial tubes, making it harder to breathe and resulting in the classic croup symptoms. The condition is contagious and can spread through respiratory droplets when an infected person coughs or sneezes.

Symptoms

The hallmark signs of croup include:

  • Barking cough – Sounds like a seal or dog bark

  • Hoarseness – Due to inflamed vocal cords

  • Stridor – A high-pitched, wheezing sound heard during inhalation

  • Fever – Mild to moderate in most cases

  • Runny nose and nasal congestion – Often precedes the cough

Symptoms tend to worsen at night and may improve during the day. In severe cases, children may struggle to breathe or appear agitated or lethargic.

Types

There are several types of croup:

  • Viral croup: The most common form, caused by a viral infection.

  • Spasmodic croup: Sudden onset, often at night, not always associated with fever or viral illness.

  • Bacterial croup (bacterial tracheitis): A rare but serious condition requiring immediate medical attention.

Diagnosis

Healthcare providers typically diagnose croup based on a child’s medical history, symptoms, and a physical exam. Listening to the child's breathing and noting the presence of stridor or barking cough is often enough for diagnosis.

In more severe or uncertain cases, additional tests such as neck X-rays or pulse oximetry to measure oxygen levels might be used.

Treatment

Treatment depends on the severity of the condition:

Mild cases:

  • Humidified air (cool mist humidifier)

  • Warm showers or steam inhalation

  • Adequate fluid intake

  • Keeping the child calm to avoid worsened breathing

Moderate to severe cases:

  • Corticosteroids (e.g., dexamethasone) to reduce airway inflammation

  • Nebulized epinephrine for severe airway swelling

  • Hospitalization in cases of respiratory distress

Avoid giving cough medicines unless advised by a healthcare provider, as they can be harmful to young children.

Home care tips

  • Sit with your child in a steamy bathroom or use a humidifier

  • Keep them upright to ease breathing

  • Encourage small, frequent sips of fluid

  • Monitor for signs of worsening: fast breathing, retractions (chest pulling in), or cyanosis (bluish skin color)

When to see a doctor

Seek immediate medical attention if your child:

  • Struggles to breathe

  • Has noisy breathing even at rest

  • Shows signs of dehydration

  • Appears unusually drowsy or confused

  • Develops blue lips or face

Complications

Most children recover without complications. However, potential risks include:

  • Respiratory distress

  • Secondary bacterial infections (e.g., pneumonia or bacterial tracheitis)

  • Frequent recurrence in cases of spasmodic croup

Prompt treatment and follow-up can help prevent complications.

Prevention

  • Practice good hand hygiene

  • Avoid contact with sick individuals

  • Keep your child’s immunizations up to date (especially flu and COVID-19 vaccines)

  • Disinfect commonly touched surfaces

Living with croup

Most children recover in a few days, though the cough may linger for up to a week. With supportive care and proper management, the prognosis is excellent. Parents should watch for recurring episodes and consult their pediatrician if symptoms return frequently.

Frequently asked questions

1. Can adults get croup? Rarely, but it can happen. Adults usually experience milder symptoms.

2. Is croup dangerous? In most cases, it’s mild. However, severe cases can lead to breathing problems and require urgent care.

3. How long does croup last? Usually 3 to 5 days.