Respiratory
If your child wakes at night with a barking cough: croup
Short clinical summary
Croup arises from viral swelling of the region just below the vocal cords. The typical picture is a sudden onset at night of a barking cough, hoarseness and a harsh sound on inspiration (stridor). Most episodes are mild and settle within a few days. Stridor heard at rest, marked retractions or bluish discolouration require urgent assessment.
What is croup?
Croup (laryngotracheobronchitis) is a viral condition in which the upper airway narrows at and just below the level of the vocal cords. It is most common between 6 months and 3 years of age. Because the airway diameter is already narrow in young children, even slight swelling produces a marked change in the sound of breathing.
Parainfluenza viruses are the most frequent cause, although other respiratory viruses can produce a similar picture. Croup is therefore seen more often in autumn and winter.
How do the typical symptoms progress?
Croup usually begins with one or two days of mild cold symptoms and a low-grade fever. Then, often in the middle of the night, the following appear suddenly:
- Barking cough: A harsh, metallic cough often likened to the bark of a seal.
- Hoarseness: Due to local swelling of the vocal cords.
- Stridor: A harsh whistling sound on breathing in. Initially heard only when the child cries or moves; in more severe cases, also at rest.
Symptoms increase markedly at night and ease during the day. This fluctuation is one of the features that surprises families most. Symptoms typically settle within 3–5 days, with the first two nights the most intense.
Why does crying make it worse?
When a child cries and becomes distressed, the respiratory rate rises, air passes more rapidly through the narrowed segment, and stridor becomes more pronounced. Calming the child is therefore the first and most easily applied step in croup. Holding them upright, on your lap, and speaking in a calm tone all help.
What should you do at home?
- Calm your child and, where possible, hold them upright on your lap.
- Maintain fluid intake; small, frequent amounts are better tolerated.
- If there is fever, an antipyretic may be used in line with medical advice.
- Monitor breathing: respiratory rate, retractions below the ribs or in the neck, lip colour.
- Avoid irritant exposure such as cigarette smoke.
What not to do
- Exposing the child to hot steam: this carries a burn risk and has not been shown to help.
- Using cough syrups or antibiotics without medical advice.
- Giving medication that was prescribed for another child.
- Forcing the child to lie down and increasing their distress.
What treatments does a physician consider?
Croup treatment is planned according to severity. Examination assesses the presence of stridor at rest, the degree of retractions, respiratory rate, oxygenation and the child's general condition.
In mild cases a single dose of corticosteroid is often sufficient; this reduces airway swelling. In more severe cases nebulised adrenaline may be given and the child observed for a period. Because croup is viral in origin, antibiotics have no routine role.
These decisions can only be made after examination, so if findings are pronounced, medical assessment should not be delayed.
When should you seek medical care?
Findings requiring urgent assessment
- Stridor heard at rest, that is, while the child is calm
- Retractions below the ribs, in the neck or above the collarbones
- Bluish discolouration of the lips, tongue or face
- Extreme lethargy, difficulty waking, or inconsolable distress
- Drooling, inability to swallow, or laboured breathing while sitting leaning forward
- Inability to take fluids, reduced urine output
- A croup-like picture in an infant under 6 months
Even when findings are mild, medical assessment is recommended for a first episode of croup. Recurrent croup episodes are a separate situation that warrants evaluation.
Frequently asked questions
Is croup contagious?
The viruses that cause croup are contagious. The same virus may cause croup in one child and only cold-like symptoms in another. Hand hygiene and reducing close contact with unwell children help limit transmission.
Does steam help in croup?
There is no strong evidence that humidified air changes the course of croup, and hot steam carries a risk of burns. What matters is calming the child and monitoring for signs of respiratory distress; treatment decisions are made after medical assessment.
Are antibiotics needed for croup?
Croup is overwhelmingly viral, so antibiotics are not effective and are not routinely recommended. Treatment may include corticosteroids and, where necessary, nebulised adrenaline.
How long does croup last?
Symptoms usually settle within 3–5 days and are typically most pronounced on the first two nights. The cough may persist a little longer. If symptoms worsen or stridor appears at rest, reassessment is needed.
Does croup recur?
Some children experience recurrent croup episodes. Where attacks are frequent, assessment for airway structural causes, an allergic background or contributing conditions such as reflux is appropriate.
References
This content is based on the source types listed below.
- Upper respiratory tract infection chapters of current pediatric textbooks.
- Croup diagnosis and management guidelines published by national and international pediatric societies.
- Systematic reviews on corticosteroid and nebulised adrenaline use in croup.
- Child health information resources of the Turkish Ministry of Health.
This content is provided for general information purposes and does not replace individual medical assessment, diagnosis or treatment. Please consult your physician for decisions specific to your child.
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Author and medical reviewer
Ayça Sözen, MD
Specialist in pediatrics. Residency in pediatrics at Maltepe University Faculty of Medicine (2013–2017) and faculty appointment (2019–2023). With Acıbadem Healthcare Group since 2020; currently seeing patients at Acıbadem Ataşehir Hospital.
Appointments are arranged through the official appointment channels of Acıbadem Ataşehir Hospital; they cannot be booked directly through this website.