Croup Symptoms and Treatment

A Common Childhood Viral Infection

Sick child in bed
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Croup is a common childhood viral infection that is easily recognized because of several of its distinctive characteristics.

Croup, also called laryngotracheobronchitis, most commonly affects children between the ages of six months and three years, usually during the late fall, winter, and early spring. Symptoms, which often include a runny nose and a brassy cough, develop about 2 to 6 days after being exposed to someone else with croup (incubation period).

Signs and Symptoms of Croup

One of the first distinctive features of croup is the abrupt or sudden onset of symptoms. Children will usually be well when they went to bed, but will then wake up in the middle of the night with a croupy cough and trouble breathing. The sound of the cough is also distinctive. Unlike other viral respiratory illnesses, which can cause a dry, wet, or a deep cough, croup causes a cough that sounds like a barking seal.


The pattern of croup symptoms is also characteristic. In addition to beginning in the middle of the night, symptoms are often better during the day, only to get worse again the next night.

Symptoms also become worse if your child becomes anxious or agitated.



Other croup symptoms can include a hoarse voice, sore throat when your child coughs, decreased appetite and a fever, which is usually low grade but may rise up to 104 F.

Assessing Kids with Croup

Because of the characteristic symptoms and signs of croup, the diagnosis is usually fairly easy to make. If you hear them cough, you can often tell a child has croup while they are still in the waiting room or before you enter the exam room, therefore, testing is usually not necessary.

Specifically, an X-ray is usually not required and is usually only done to rule out other disorders, such as ingestion of a foreign body. When an x-ray is done, it will usually show a characteristic 'steeple sign,' which shows a narrowing of the trachea.


They may also have stridor when they are resting.



Croup Treatments


Mild croup symptoms can usually be safely treated at home. Common treatments include using humidified air, which can be delivered by a cool mist humidifier. Using a hot steam vaporizer is usually discouraged because of the risk of your child getting burned if he touches it. Instead, warm steam can be delivered by turning on all of the hot water in the bathroom, including from the shower and sink, close the bathroom door and holding your child as he breathes in the steamy, humidified air.


Other treatments can include using a fever reducer (acetaminophen or ibuprofen containing products) and/or a non-narcotic cough syrup (although they probably won't suppress the cough of croup) if your child is over four to six years old.

Since symptoms worsen if your child is crying and agitated, trying to keep your child calm may also improve his symptoms.


For children with severe respiratory distress, treatment, in a hospital setting may include a breathing treatment with racemic epinephrine. Because there is a risk of a 'rebound' and worsening breathing, children are usually observed for 2 to 4 hours after receiving racemic epinephrine. Children who continue to have difficulty breathing, or who require more than one treatment, are usually hospitalized.


What To Know About Croup

In addition to these tips on recognizing and treating croup, other things to know about croup include:

  • Your child can get croup more than once, as there are many viruses that can cause croup, including parainfluenza, adenovirus, respiratory syncytial virus (RSV) and influenza (the flu virus), and there are multiple subtypes of each virus.
  • If your child is getting croup very often, then he may have spasmodic croup (acute spasmodic laryngitis), which can be triggered by viruses, allergies or reflux. Although they may have trouble breathing, children with spasmodic croup often don't have a fever and get better quickly after several hours.
  • Kids who get diagnosed with croup multiple times each year might also need to be evaluated for asthma.

Although there is no vaccine (except for the flu vaccine) or medication that can prevent your child from getting croup, you might decrease the chance that your child will get croup by decreasing his exposure to other people who are sick. Also, encourage strict hand washing and avoiding sharing foods and drinks can help to lessen your child's chances of getting sick.


Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (Eighth Edition), Volume 1, 2015

Mayo Clinic. ​Croup

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