Quick answer: Croup is a common viral infection that swells the upper airway in young children, usually ages 6 months to 3 years. It causes a loud, barking cough that sounds like a seal, often starting suddenly at night. Most cases are mild and get better in 3 to 5 days. Bring your child to urgent care if the cough is getting worse, they make a harsh, high-pitched sound when breathing in while calm, or they have a fever. Call 911 if your child is struggling to breathe, drooling, can’t speak or cry, or their lips turn blue.

Few things are as scary as waking up to your toddler’s barking cough at 2 AM. Here’s what croup is, how to help at home, and when to get care.

What is croup?

Croup is swelling around the voice box (larynx) and windpipe (trachea), usually caused by a virus. Parainfluenza viruses are the most common cause, but RSV, flu and COVID can cause it too. Because young children have small airways, even a little swelling makes breathing noisy. Croup is most common in fall and winter.

Croup symptoms

  • A loud, barking cough, often compared to a seal
  • A hoarse voice or cry
  • Stridor: a harsh, high-pitched, squeaky sound when breathing in
  • Cold symptoms first, like a runny nose and mild fever
  • Symptoms that are worse at night and when crying or upset

Croup usually lasts 3 to 5 days, and the first 2 or 3 nights are often the worst.

How to help your child at home

  • Stay calm and keep your child calm. Crying makes the swelling and breathing worse. Hold them upright and comfort them.
  • Try cool air. Some parents find that 10 to 15 minutes of cool night air (bundled up outside or by an open window) or a cool-mist humidifier helps.
  • Offer fluids to keep them hydrated.
  • Treat fever and discomfort with acetaminophen or ibuprofen, dosed by your child’s weight (no ibuprofen under 6 months).
  • Sleep nearby so you can hear changes in their breathing.

Don’t give cough or cold medicines to children under 4 unless a doctor tells you to.

When to bring your child to urgent care

  • Stridor when your child is calm and resting
  • The barking cough is getting worse or lasts more than 5 days
  • Fever over 102°F, or any fever in a baby under 3 months (go to the ER for infants under 3 months)
  • Your child seems more tired or fussy than usual
  • Signs of dehydration, such as fewer wet diapers or no tears when crying

At PACS, our providers can examine your child, check their oxygen level, and treat croup. Many children with croup are given a single dose of a steroid medicine to bring down the airway swelling. Learn more about pediatric urgent care and when to take your child to urgent care.

When to call 911

Call 911 or go to the nearest ER right away if your child:

  • Is working hard to breathe: the skin pulls in between the ribs or at the base of the neck
  • Has blue or gray lips, skin or nails
  • Is drooling or can’t swallow
  • Can’t speak or cry because they can’t get enough air
  • Has stridor that is getting louder, or suddenly gets quiet while still struggling
  • Is very sleepy or hard to wake

Croup vs. RSV vs. whooping cough

  • Croup: barking cough and noisy breathing in. Affects the upper airway.
  • RSV and bronchiolitis: wheezing, fast breathing and lots of mucus. Affects the small airways in the lungs. See RSV in babies and older adults.
  • Whooping cough: long coughing fits that may end in a “whoop” or vomiting. Needs prompt testing and treatment.

Frequently asked questions

Is croup contagious?

Yes. The viruses that cause croup spread through coughs, sneezes and touching shared surfaces. Wash hands often and keep sick kids home from daycare.

When can my child go back to daycare?

Usually once they’ve been fever-free for 24 hours without medicine and feel well enough for normal activities. Ask your provider.

Can adults get croup?

It’s rare. Adults have larger airways, so the same viruses usually cause just a sore throat or hoarse voice.

Does my child need antibiotics for croup?

No. Croup is caused by viruses, so antibiotics won’t help.

Where can I learn more?

See croup information for parents from the American Academy of Pediatrics (HealthyChildren.org).

Get care today at PACS Urgent Care

Walk in or check in online at our Alexandria urgent care (3481 N Beauregard St, open 7 days, 8 AM to 8 PM) or our Ruther Glen urgent care (17067 Merchants Dr, Monday to Friday 8 AM to 8 PM, Saturday and Sunday 9 AM to 5 PM). Not sure if your child needs to be seen? Start with a telemedicine visit.

This article is general information and is not a substitute for advice from your own clinician.