Croup is a common childhood respiratory problem that affects the windpipe (trachea), the airways to the lungs (the bronchi) and the voice box (larynx). It is usually caused by a virus and leads to swelling inside the trachea, which interferes with normal breathing and produces symptoms of “barking” cough and a hoarse voice. 


Croup is most common during the winter and mainly affects young children between three months and three years, because they have narrower and more sensitive trachea.


APPOTEK can help you with croup.


Viruses are the most common cause of croup symptoms. Many respiratory viruses can infect the vocal cord area and cause narrowing. Even influenza (the flu) can do this. A fever is often present with the barky cough.


Viral croup is an infection of the larynx which usually starts with a runny nose and then leads to the swelling of vocal cords, the mucous membranes of the larynx and throat. It causes strained breathing and a barking cough. 


Symptoms include Stridor (a high-pitched, wheezing sound caused by disrupted airflow), hoarseness and difficulty breathing – which usually worsens at night. Stridor is worsened by agitation or crying, and if it can be heard at rest, it may indicate a critical narrowing of the airways. As croup worsens, stridor may decrease considerably.


Other symptoms include fever and an indrawing of the chest wall, known as ‘Hoover’s sign’. Drooling or a very sick appearance can indicate other medical conditions, such as epiglottitis or tracheitis.

Prevention and protection

Many cases of croup can be prevented by immunization for influenza and diphtheria.


For most children, croup is a mild illness that can be managed at home and usually gets better on its own within 48 hours. Still, croup can be scary, especially if it lands your child in the doctor’s office, emergency room or hospital.


Treatment is typically based on the severity of symptoms.


Comfort measures

Comforting your child and keeping him or her calm are important, because crying and agitation worsen airway obstruction. Hold your child, sing lullabies or read quiet stories. Offer a favorite blanket or toy. Speak in a soothing voice. 


It can also help to:


  • sit your child upright 
  • give them plenty of fluids
  • Fresh, slightly chilly air also reduces swelling, so it can help to open a window or take the baby on a walk. 


Don’t put your child in a steamy room or get them to inhale steam. Don’t give them cough or cold medicines


If your child’s symptoms persist beyond three days or worsen, you should consult a doctor, who may prescribe these medications:


  • A type of steroid (glucocorticoid) may be given to reduce inflammation in the airway. Benefits will typically be felt within a few hours. A single dose of dexamethasone is usually recommended because of its long-lasting effects.
  • Epinephrine also is effective in reducing airway inflammation and may be given in an inhaled form using a nebulizer for more-severe symptoms. It’s fast acting, but its effects wear off quickly. Your child likely will need to be observed in the emergency room for several hours before going home to determine if a second dose is needed.


For severe croup, your child may need to spend time in a hospital to be monitored and receive additional treatments.

When to consult a doctor

Severe croup can cause breathing difficulties in general but if your child’s skin “caves in” around their neck or ribs when they try to inhale, you should seek urgent medical treatment. Serious infections can also cause stridor, which is noisy breathing, often high-pitched, caused by the narrowing of the airway. In this case you should also see a doctor. 


Get urgent medical treatment if your child:


  • becomes pale or gets blue-colored lips and fingers
  • gets very high fever
  • has difficulty breathing.

How APPOTEK can help

APPOTEK can help you with mild croup. A nurse or doctor will make an individual assessment based on your child’s symptoms, then may prescribe treatment or refer you for further examination. If symptoms are severe or your child has difficulty breathing, always go directly to the emergency room.


Vadym Diadiun, Doctor of Medicine, M.D.