Croup in Children — Irish Parent Guide

What is croup?

Croup (acute laryngotracheobronchitis) is a viral infection of the upper airway causing swelling around the voice box and windpipe. It produces the distinctive "barking" cough — often compared to a seal's bark — along with a hoarse voice and sometimes a high-pitched noise when breathing in called stridor. Most common in children aged 6 months to 3 years, peaking in autumn and early winter in Ireland.

Most croup is mild — manageable at home over a few nights. A smaller proportion (around 5%) is moderate-to-severe and needs medical assessment, with a very small percentage requiring hospital admission.

Typical course

Per NICE CKS:

• Day 1–2: cold-like symptoms — runny nose, mild fever, slight cough
• Day 2–3: characteristic barking cough develops, hoarseness, sometimes stridor when upset or asleep
• Day 3–4: symptoms typically worst — often dramatically worse at night
• Day 5–7: gradual resolution

Symptoms tend to be much worse at night and improve in the morning — this is normal and not a sign things are getting worse.

When to seek urgent help — red flags

Call 999/112 or attend emergency immediately if your child has any of:

• Continuous stridor even when calm or asleep
• Difficulty breathing — sucking in at ribs/neck, fast breathing, exhaustion from effort
• Bluish lips or tongue
• Drooling or difficulty swallowing saliva
• Unable to speak or cry properly because of breathing difficulty
• Very pale or sweaty appearance
• Drowsiness, floppiness, or extreme unresponsiveness
• Very high fever with unwell appearance — consider other causes (epiglottitis, bacterial tracheitis)

Anything that prevents a young child sucking saliva back or causes them to lean forward, drool, and refuse to lie down warrants emergency assessment — this can suggest epiglottitis, a different and serious condition.

Home management of mild croup

For mild croup (barking cough, no stridor at rest, breathing comfortable):

• Calm yourself first — children pick up parental anxiety, and crying worsens stridor
• Sit with the child upright — comfort, cuddle, calm voice
• Paracetamol or ibuprofen (paediatric formulations, age-appropriate) if uncomfortable or feverish
• Offer fluids regularly
• Cool fresh air sometimes helps — a few minutes at an open window
• Steam inhalation (e.g. running a hot shower) — gentle exposure to humid air for 10 minutes can settle mild croup; never put a child near boiling water or use scalding steam — burn risk

Steroid treatment

For moderate-to-severe croup (stridor at rest, breathing effort), per NICE: a single dose of oral dexamethasone (or budesonide nebulised) is highly effective and works within 30 minutes to 2 hours. This is usually given via your treating doctor or emergency department. If you have already had a positive response to oral steroid, recurrences may sometimes be reassessed quickly — discuss with the Online Doctor.

When an Online Doctor consultation is useful

Online Doctor consultation is appropriate for: mild persistent symptoms during the day, advice on whether home management is enough, second opinions, or follow-up after an episode. For moderate-to-severe croup with stridor or breathing difficulty, in-person assessment is required.