Croup: The Barking Cough, and When It's an Emergency

Croup is a viral infection that swells the upper airway in young children, causing a loud, barking cough that sounds like a seal, a hoarse voice and sometimes a high-pitched noise when breathing in. Most croup is mild and gets better within a few days with care at home. It becomes an emergency when a child is working hard to breathe, makes that noisy breathing sound while calm and resting, or turns blue or gray around the lips.

What is croup?

Croup is an infection of the voice box (larynx) and windpipe (trachea), usually caused by common cold viruses, most often parainfluenza. In young children the airway is narrow, so even a little swelling makes a big difference to how air moves. That's what produces the distinctive cough and the noisy breathing.

It's most common between about 6 months and 5 years of age, and it peaks in fall and early winter. Older children and adults can catch the same viruses, but their wider airways usually mean they get a cold or sore throat rather than croup.

What does croup sound like?

The croup cough is hard to mistake once you've heard it: a tight, barking cough, like a seal. Other common croup symptoms:

• A hoarse or raspy voice, or crying that sounds hoarse
• Stridor: a harsh, high-pitched, squeaky sound when breathing in
• Fever, runny nose and a stuffy nose, often for a day or two before the cough starts
• Symptoms that are much worse at night, often waking the child suddenly

Stridor that happens only when a child is crying or upset is common with croup. Stridor while calm and resting means the airway is more swollen, and it needs to be seen right away.

How long does croup last?

The barking cough is usually worst on the first two or three nights and improves over 3 to 5 days. A lingering cough from the cold can hang on a bit longer. Croup can come back with later colds in some children.

What can you do at home?

For a child with a barking cough who is breathing comfortably at rest:

• Keep your child calm. Crying and agitation make the airway narrower and the breathing noisier. Hold them, read a story, or put on a favorite show.
• Try cool air. Many parents find that a few minutes in cool night air (bundled up) or by an open freezer helps. Evidence for steam and humidifiers is mixed, so don't rely on them, and never use hot steam, which can scald.
• Offer fluids often, and let them rest.
• Use fever reducers as the label directs for your child's age and weight, if fever is making them uncomfortable.
• Sleep nearby, so you can hear any change in their breathing overnight.

Don't give over-the-counter cough and cold medicines to young children unless a clinician tells you to. They don't help croup and can cause side effects.

When should you bring your child in?

Come to urgent care the same day if:

• The barking cough is new, and you'd like your child checked
• Stridor happens when your child is upset, even if it settles with calming
• Fever lasts more than 3 days, or your child seems to be getting worse instead of better
• The cough has lasted longer than a week
• Your child isn't drinking well
• Croup keeps coming back

At the visit, a clinician will listen to your child's breathing and watch how hard they're working to breathe. For more significant symptoms, a clinician may discuss a medicine to reduce the airway swelling or a breathing treatment. Our croup page has more on how we approach it.

Call 911 or go to the ER if your child is struggling to breathe, the skin is pulling in between the ribs or at the base of the neck, there's stridor while calm and resting, the lips or skin look blue or gray, they're drooling or can't swallow, they can't speak or cry because of breathlessness, or they're very sleepy, limp or too tired to cry or drink.

Is it croup, or something else?

A barking cough is the classic sign of croup, but noisy breathing has other causes too. An inhaled object, such as a small toy or piece of food, can cause sudden coughing and noisy breathing without a cold beforehand. That needs emergency care. A cough with wheezing (a whistling sound on breathing out) points more toward an asthma flare or another chest infection. If you aren't sure, have your child checked.

What does a visit cost?

An in-clinic visit starts at $175 self-pay, and the final tier depends on the care provided. For example, a visit with a breathing treatment is $250 self-pay. The cost and insurance page explains the tiers. We contract with all major commercial and government plans, including Colorado Medicaid and Medicare. We can't guarantee a commercial plan has us in network, and if you're out of network or your benefits are denied, we bill you at our self-pay rates.

Where to find us

Four clinics across metro Denver, all ages welcome, se habla español:

• Hampden (Southeast Denver): 8 AM–11 PM daily
• Littleton: 8 AM–11 PM daily
• Thornton: 8 AM–11 PM daily
• Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM

Walk in, or book online.