Croup in Children — First Aid

What to do

Recognise croup: a barking, seal-like cough, a harsh rasping sound when breathing in (stridor), and a hoarse voice, usually in a child under 6, often starting suddenly at night. It is caused by swelling of the upper airway.
Stay calm and keep the child calm — crying and agitation worsen the breathing difficulty. Hold the child upright on your lap, which usually eases breathing.
Call 911 or seek urgent medical care if the child has stridor at rest that does not settle, is drooling or unable to swallow, looks pale or blue, is drowsy, or is working hard to breathe (ribs showing, head bobbing).
Cool night air sometimes soothes croup — take the child outside or to an open window while you assess and decide on help. (Steam from a shower is a traditional remedy with little evidence; never risk scalds.)
Do not look deep into the child's throat or put anything in the mouth — it can worsen the obstruction.
If the child is seen medically, a single dose of steroid medicine is the usual hospital treatment and works within a few hours; severe cases may receive nebulised adrenaline. Croup often recurs for a few nights, improving each night.

What NOT to do

Do not examine the throat with a spoon or fingers.
Do not leave a child with noisy breathing at rest alone in bed — stay with them and monitor.
Do not drive a struggling child to hospital yourself if an ambulance is available — breathing can worsen en route.
Do not give cough or cold medicines to settle croup — they do not treat airway swelling.

When to get medical care

Urgent same-night assessment for any child with stridor (harsh in-breath noise) at rest, increased work of breathing, drooling, drowsiness, pale or blue colour, or a barking cough in a baby under 6 months. Croup usually peaks on the second or third night; seek review again if breathing worsens after initial improvement.

Related symptoms

Frequently asked questions

Why does croup start at night?

Croup symptoms characteristically worsen in the evening and night, for reasons that are not fully understood, and improve towards morning. Parents are often caught out by a child who seemed mildly unwell at bedtime waking with a barking cough at 2 a.m.

Is croup dangerous?

Most cases are mild and settle with calm care and, when needed, a steroid dose. A minority cause significant airway obstruction because young children's airways are narrow — the warning signs listed above mean urgent help.

In an emergency, call 911 (or your local emergency number) first — do not delay a call to read a guide. These pages are educational first-aid information in general terms; they are not a substitute for emergency services, first-aid training, or assessment by a qualified clinician.