Whenever your child has a cough, you probably go through the list of possible causes in your head. Is it COVID‑19? Is it strep? Is it a cold or allergies? How can you tell?
Your child could also be experiencing croup, an illness that many kids experience during the fall and winter months.
Nazima Zakhidova, M.D., pediatrician with Children's Health℠, shares signs of croup in kids and when to see a doctor.
What is croup?
Croup is an infection in the upper airway that causes your child's voice box (larynx) and windpipe (trachea) to swell. The swelling narrows the airway and obstructs breathing, making your child's breathing very noisy. When they cough, it sounds like a bark.
How do kids get croup?
Viruses, such as parainfluenza, are the most common cause of croup. Bacterial infections, like Haemophilus influenzae type b (HIB), can also cause croup but it is uncommon in the U.S. due to vaccines.
Some children may also experience spasmodic croup, which can be related to allergies or acid reflux. This type of croup can be scary because it can come on quickly, often in the middle of the night, when a child wakes up struggling to breathe. Children with this type of croup don't typically have a fever.
Croup is more common in younger kids aged 3 months to 5 years old. As your child grows, their airways become larger and less susceptible to croup.
What are signs of croup in kids?
Viral croup might begin like a cold, with a stuffy nose, fever and fatigue. But over time, your child will develop a cough, a hoarse or scratchy voice, and breathing that is noisy and labored. A croup cough in kids is often described as a “barking” cough. Croup caused by allergies or reflux comes on suddenly with no previous symptoms.
Does croup cause fever?
Children with viral croup may have a fever that can be controlled with fever-reducing medication. However, not all cases of viral croup cause fever and most children with spasmodic croup do not have a fever.
What does croup cough sound like?
A croup cough sounds like barking (often compared to a barking seal). Children might also have stridor, a squeaking or whistling noise when they breathe in.
You can find examples of both croup cough and stridor sounds online. You can compare those examples to your child's cough to help you figure out if your child might have croup. If you are concerned your child might have croup, contact your child's primary care provider. Since croup symptoms are typically worse at night, Dr. Zakhidova recommends recording your child's cough at night to share with your pediatrician. They will be able to evaluate your child's symptoms and provide a diagnosis.
Croup vs. COVID‑19
Symptoms of COVID‑19 in children may be similar to many other common illnesses, including croup. Both croup and COVID‑19 can cause cold-like symptoms, fever and cough.
"It's important to remember that many respiratory viruses, like the common cold and flu, can also cause croup," Dr. Zakhidova says.
If your child is coughing and showing cold-like symptoms, it is best to get them tested for COVID‑19 so you can protect yourself and others. Remember, getting your child vaccinated is the best way to prevent severe COVID‑19 symptoms. If you think your child may have COVID‑19, watch for these warning signs that they need emergency care.
Is croup contagious?
Viral croup can be contagious. When your child coughs or sneezes, they may spread viruses through the air.
Adults and older children can get infected with the virus that causes croup. However, older kids and adults probably won't develop croup cough and stridor. This is because their airways are larger, so while swelling is uncomfortable, it doesn't make it hard to breathe.
How long is croup contagious?
Croup in kids is generally considered contagious for about 1 day before symptoms start and up to 4-5 days after they first develop symptoms.
"Overall, a child with croup is less contagious when they've been fever-free for 24-hours, when they have fewer symptoms than they did before, and when they are feeling better," explains Dr. Zakhidova.
How long does croup cough last?
Fortunately, croup is typically mild and lasts about a week. Symptoms may appear to be mild at first, worsen on day 3-5 and then get better. Symptoms also tend to be more severe at night.
How do you treat croup?
Your child's treatment will depend on how severe their symptoms are. Most cases of croup can be treated at home.
If your child is experiencing stridor or a barking cough, the sound may scare them, making it even harder for them to breathe. It's important you stay calm and help them calm down by hugging them or rubbing their back. Having your child breathe in sudden cold air (for example from outside or from the freezer) can also help calm down their cough.
If your child has a fever, give them plenty of fluids. If their fever is going up, you can give them appropriate doses of fever-reducing medications (such as acetaminophen or ibuprofen) to help bring it down. Check the label or call your pediatrician for the correct dosage for your child. See other ways to help manage fever in children.
Cool, moist air can also be soothing for a swollen throat. You can put a cool-mist humidifier in your child's room to help them breathe better at night. See other home remedies for cough in children.
If your child has severe croup symptoms, they might need breathing treatments and/or steroids to reduce swelling. Your doctor can help you determine if your child needs this treatment.
When to call a doctor for croup?
Call your pediatrician if your child is less than 2 years old and appears to be struggling with stridor and cough.
When to go to the hospital for croup?
In rare cases, swelling in your child's airway can be dangerous. You should seek immediate medical attention at an emergency room or call 911 if your child:
- Can't speak because they are struggling to breathe
- Has bluish lips or fingernails (cyanosis)
- Has stridor when lying still or sleeping
- Has excessive drool or seems to have trouble swallowing saliva
- Makes whistling noises that get louder with every breath
- Struggles to catch their breath
"If croup progresses to having persistent stridor at rest with labored breathing, this is cause for worry, and you should take your child to the emergency room," explains Dr. Zakhidova. A doctor can give your child medicines to take the swelling down quickly.
Can croup be prevented?
Many parents wonder if there are ways to prevent croup in kids. There is no vaccine to prevent croup, but staying up-to-date on immunizations, including those against the flu, COVID‑19 and RSV in babies who are eligible, can help prevent viruses that can cause croup. You can also reduce your risk of contracting common viral illnesses by:
- Washing hands often and encouraging proper handwashing technique
- Avoiding touching your face if you haven’t washed your hands
- Covering coughs and sneezes
- Cleaning and disinfecting frequently touched surfaces
- Staying home if you are sick and avoiding close contact with others who are sick
Learn more
The Primary Care Clinic at Children's Health is here to care for all aspects of your child's health, from well-child exams and treatment of common illnesses to treatment of chronic conditions. Learn more about our primary care services.
Get care now
You can also videoconference with a health care provider 24 hours a day, 7 days a week with Virtual Visit by Children's Health Virtual Care. Learn more and download the Virtual Visit app today.
Thank you!
You are now subscribed to the Children's Health Family Newsletter.
Children's Health will not sell, share or rent your information to third parties. Please read our privacy policy.