Barky Cough (Croup)

• Croup is a common viral infection that causes noisy breathing and a barky cough in young children
• Croup is usually mild and can be managed at home using cool air
• Croup is caused by a virus and does not need antibiotics
• Seek medical attention if you notice that your child has noisy breathing when calm or asleep, or has any trouble breathing

Croup is a common viral illness in children. The virus causes swelling of the throat, including the larynx (around the vocal cords) and the trachea (windpipe, or air passage from the throat to the lungs).

The swelling in the throat can change your child’s voice and cause a harsh, “barky” cough. Children with croup can get stridor – a high-pitched breathing sound made when they take a breath in, which can lead to difficulty breathing.

Croup affects younger children because their airways are smaller. Children between the ages of three months and five years old are most likely to get sick, but older children may have symptoms too. The same virus that causes croup in a young child can give cold symptoms to other family members.

Most children will have a mild runny nose or a low-grade fever. Within 12 to 48 hours, the symptoms can progress to include:

• Hoarse voice
• “Barking” or “Seal-like” cough
• Stridor (A high pitched noise when your child takes a breath in)
• Fever
• Mild sore throat
• Trouble breathing

In mild cases of croup, stridor is normally heard when your child is crying or upset. In more severe cases of croup, your child will have stridor even when they are calm or asleep. Stridor and cough are usually worst at night.

Children are unwell for about one week. Croup symptoms are worst during the first 1-2 days that your child is sick. Your child may have other symptoms because of the virus making them sick, including: runny nose, red eyes, or rash.

At Home

Most children with croup have mild symptoms and can be successfully treated at home. Here are some things you can try to make your child feel better:

1. Cool air
   • Cool air can help "shrink" the swollen tissues in the upper airway - this can make their breathing more comfortable and settle their coughing. Dress your child in warm clothes and try any of the following:
     • Keep your home temperature on the cooler side
     • Open a window in your child's room
     • Take your child outside for 5 to 10 minutes
     • Take your child for a drive with the windows partly rolled down
     • Open the freezer door and let your child breathe in the cool air
2. Over the counter medication for fever or pain
   • You may give Acetaminophen (Tylenol® or Tempra®) or Ibuprofen (Advil® or Motrin®) to keep your child comfortable. Use as directed on the packaging or instructed by a health care provider
3. Fluids
   • Your child may not have their normal appetite, but encourage your child to stay hydrated by offering small amounts of fluids throughout the day. Cool drinks can be soothing if they have a sore throat
4. Rest
   • Encourage your child to rest. Their cough may become worse if they get excited, upset or are very active
   • Many children have a cough and trouble breathing at night – you may want to sleep in the same room as your child. This will let you know if there are any problems at night

In Hospital

1. Dexamethasone (Steroid syrup)
   • If cool air is not effective at helping your child’s breathing, your child may need a medication called ‘Dexamethasone’
   • Dexamethasone is a steroid syrup that helps reduce the swelling in the airways. The medication usually starts to work 3 to 4 hours after your child takes it, and continues working for 1 to 2 days
2. Inhaled Epinephrine
   • In children with difficulty breathing or stridor when they are calm or asleep, inhaled epinephrine (adrenaline) may be used
   • Your child breathes in the medication through a mask, and the epinephrine works in a few minutes to reduce swelling in the airway and lasts about four hours
   • If your child is unwell enough to require inhaled epinephrine, they are usually watched in the Emergency Department for several hours. Some children require more than one dose of the medication

How Can I Prevent It From Spreading?

• Croup is contagious – your child should be kept away from daycare/school as long as they have a fever and barky cough
• Keep your child away from young babies (less than three months) for as long as you can while they are coughing
• Hand washing is important to stop the spread of infections. Teach children to wash their hands before and after eating, coughing or sneezing

Additional Information

• Croup Symptoms and Management (Video and eBook)