Croup

Croup is a common childhood viral infection causing swelling of the upper airway, resulting in a characteristic barking cough and, in some children, noisy breathing. It most often affects children between six months and six years old.

• A distinctive barking cough, often described as sounding like a seal
• Hoarse voice or cry
• Noisy, high-pitched breathing sound when breathing in (stridor), particularly when upset or crying
• Symptoms often worsen at night
• Fever, usually mild
• In more severe cases, stridor at rest and chest indrawing indicate significant airway narrowing requiring urgent care

• Most commonly caused by a viral infection, often parainfluenza virus, causing swelling of the airway just below the vocal cords.
• Spread through respiratory droplets and contact with contaminated surfaces.
• Most common in children aged six months to six years, as their airways are narrower and more easily affected by swelling.

• Diagnosed clinically based on the characteristic barking cough and stridor, often following a day or two of cold-like symptoms.
• Severity is assessed based on the presence and degree of stridor, chest indrawing, and the child's overall distress, particularly whether stridor is present at rest rather than only when upset.

Mild croup, with barking cough but no stridor at rest, is often managed at home with comfort measures — keeping the child calm, since crying and agitation can worsen airway narrowing, and ensuring adequate fluids.

A single dose of oral corticosteroid (such as dexamethasone) is commonly given even for mild-to-moderate croup, as it reduces airway swelling and shortens the illness.

Moderate to severe croup, with stridor at rest, requires closer monitoring and may be treated with nebulised adrenaline at a health facility to rapidly reduce airway swelling, alongside corticosteroid treatment.

Children with severe distress, persistent stridor at rest despite treatment, or signs of exhaustion require urgent hospital-level care, as airway obstruction can become dangerous.

• Keep a child with croup calm, since crying and distress can worsen airway narrowing.
• Practise good hand hygiene to reduce the spread of the causative viruses.
• Seek prompt medical assessment if stridor is present even when the child is calm and at rest, as this indicates more significant airway narrowing.
• Seek immediate emergency care for severe breathing difficulty, blue-tinged lips, or exhaustion.