A Parent’s Guide to Croup: barking cough and breathlessness
Cracking the Croup Code: Understanding the Barking Cough
Croup, also called laryngotracheobronchitis, is a common breathing problem in children aged 6 months to 3 years.
It's usually caused by a virus, often the parainfluenza virus. The main sign is a sudden, barking cough that sounds like a seal. Other symptoms may include a hoarse voice, noisy breathing (called stridor), trouble breathing/ breathlessness, coughing and wheezing. Symptoms tend to get worse at night or when the child is upset.
Before the cough starts, the child might have mild cold-like symptoms, such as a runny nose, cough, stuffy nose, or fever, which last 12 to 72 hours. Croup symptoms happen because the voice box, vocal cords, and windpipe get inflamed and swollen, causing the airways below the vocal cords to narrow.
Croup can be classified as:
- Mild: A barking cough without noisy breathing or trouble breathing when calm.
- Moderate: A barking cough with noisy breathing and chest pulling in during breathing, but the child isn’t too tired or upset.
- Severe: A barking cough with noisy breathing, chest pulling in, and signs of agitation or extreme tiredness.
- Impending respiratory failure: Severe difficulty breathing with worsening airway blockage, chest pulling in, irregular chest and stomach movements, tiredness, pale or bluish skin, low alertness, or a fast heart rate. As the child becomes more tired, the chest pulling in may lessen.
Most children with mild croup can be looked after at home, and symptoms usually get better in 48 hours, though they can last up to a week. Parents or carers should give paracetamol or ibuprofen to ease fever and discomfort and get medical help if the child’s condition gets worse.
Sometimes, hospital treatment is needed, especially if the child has other health issues like lung disease, heart problems, a weak immune system, breathing faster than 60 breaths a minute, a high fever, or not drinking enough fluids. Children with moderate, severe, or life-threatening croup should be taken to hospital.
All children with croup, whether mild, moderate, or severe, should be given a single dose of oral dexamethasone (a steroid) to reduce swelling in the airways. If the child can’t take the medicine by mouth, they may be given nebulised budesonide (a steroid) or an injection of dexamethasone (another steroid) instead.
Please note the following simple advice:
- Symptoms of croup usually improve within 48 hours. More information can be found on www.nhs.uk.
- Give paracetamol or ibuprofen to relieve fever or pain.
- Make sure the child drinks fluids regularly. Continue breastfeeding if the child is breastfed.
- Check on the child regularly, including during the night.
- Go to hospital if the child has constant noisy breathing (stridor), the skin between their ribs pulls in with each breath, or if they seem restless or upset.
Call an ambulance if the child:
- Becomes very pale, grey, or blue (including their lips) for more than a few seconds.
- Is unusually sleepy or doesn’t respond.
- Struggles to breathe (for example, their belly sinks in with each breath, or the skin between their ribs or over their windpipe pulls in, or their nostrils flare).
- Is upset (agitated or restless) and struggling to breathe and cannot be calmed.
- Can’t talk, is drooling, having trouble swallowing, or prefers to sit up instead of lying down.
FAQs, especially if your child visits A&E:
Are steroids safe?
For croup, usually a low dose of steroid is given, which is quite safe. Most children respond well to this medicine and can usually go home from A&E after being watched for a short time.
This medicine may reduce the need for your child to stay in hospital and lower the chance of them needing to come back.
Importance of staying CALM:
It’s important to keep your child calm and reassure them. Being upset can make it harder for them to breathe.
If you stay calm, your child is more likely to stay calm too.
How long will my child stay in hospital?
The length of time depends on how severe the croup is. As mentioned earlier, your child might be able to go home after a short time of being observed in the Children’s Emergency Department or on a ward. Once your child is breathing more easily and is settled, they will be able to go home.
What should I do if my child gets croup again?
Try to stay calm and remember that croup often gets worse at night. Give your child paracetamol (or a similar medicine) following the instructions on the bottle. Make sure they drink plenty of cool fluids. Keep your child away from cigarette smoke, as it can make their condition worse.
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