Croup

Croup is a common childhood illness that causes a bark like cough. It can also cause difficulty breathing which can be frightening for both you and your child.

Croup is caused by a virus which affects the airways including the voice box (larynx), windpipe (trachea) and lungs (the bronchi) causing them to swell and become narrower.

Some children have croup two or more times in their childhood.

Please see Red-Amber-Green tables for advice on when and where to seek care for your child.

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When should you worry?

Newborn

NEWBORN

Contact your health visitor or GP if your baby is newborn and they…

Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
Feel very floppy, or have floppy arms or legs when awake
Move their arms and legs in repetitive jerky movements, or writhing movements
Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
Are often startling and you cannot understand why
Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other

6-8 weeks

6-8 WEEKS

Contact your health visitor or GP if your baby is 6-8 weeks and they…

Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
Feel very floppy, or have floppy arms or legs when awake
Move their arms and legs in repetitive jerky movements, or writhing movements
Have not started to bring both their hands to their face, or do not move their arms much
Keep their hands fisted, and you find it difficult to open their hands
Can’t lift their head when lying on their tummy
Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg

2-3 months

2-3 MONTHS

Contact your health visitor or GP if your baby is 2-3 months and they…

Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
Feel very floppy, or have floppy arms or legs when awake
Move their arms and legs in repetitive jerky movements, or writhing movements
Have not started to bring both their hands to their face, or do not move their arms much
Keep their hands fisted, and you find it difficult to open their hands
Can’t lift their head when lying on their tummy
Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg

3-4 months

3-4 MONTHS

Contact your health visitor or GP if your baby is 3-4 months and they…

Have lost skills which they could do before
Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
Feel very floppy when awake
Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
Move their arms or legs in repetitive, jerky, or strange ways
Still need you to support their head, or can’t lift their head when lying on their tummy
Have very tight fists and it’s hard to open their hand
Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other

4-6 months

4-6 MONTHS

Contact your health visitor or GP if your baby is 4-6 months and they…

Have lost skills which they could do before
Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
Feel very floppy when they are awake
Move their arms or legs in repetitive, jerky, or strange ways
Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
Are unable to roll, or can roll in one direction but not the other
Find it difficult to reach their arms out. For example, they do not reach for toys
Still have their early reflexes, like the startle reflex and grasp reflex
Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
Still need you to support their head

6-9 months

6-9 MONTHS

Contact your health visitor or GP if your baby is 6-9 months and they…

Have lost skills which they could do before
Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
Feel very floppy when they are awake
Move their arms or legs in repetitive, jerky or strange ways
Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
Still have their early reflexes, like the startle reflex and grasp reflex
Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
Still need you to support their head
Still need you to help turn their head when lying on their back
Can’t crawl, or find it hard, for example, drags one of their legs behind them
Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
Can’t move a toy from one hand to the other
Doesn’t use both hands to hold larger things

9-12 months

9-12 MONTHS

Contact your health visitor or GP if your baby is 9-12 months and they…

Have lost skills which they could do before
Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
Feel very floppy when they are awake
Move their arms and legs in repetitive, jerky, or strange ways
Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
Can’t move a toy from one hand to the other
Don’t use both hands to hold larger things
Don’t point to objects
Can’t crawl, or find it hard, for example, drags one leg behind them
Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support

2 months

Your Baby By Two Months

Social/Emotional Milestones

Calms down when spoken to or picked up
Looks at your face
Seems happy to see you when you walk up to her
Smiles when you talk to or smile at her

Language/Communication Milestones

Makes sounds other than crying
Reacts to loud sounds

Cognitive Milestones (learning, thinking, problem-solving)

Watches you as you move
Looks at a toy for several seconds

Movement/Physical Development Milestones

Holds head up when on tummy
Moves both arms and both legs
Opens hands briefly

4 months

Your Baby By Four Months

Social/Emotional Milestones

Smiles on his own to get your attention
Chuckles (not yet a full laugh) when you try to make him laugh
Looks at you, moves, or makes sounds to get or keep your attention

Language/Communication Milestones

Makes sounds like “oooo”, “aahh” (cooing)
Makes sounds back when you talk to him
Turns head towards the sound of your voice

Cognitive Milestones (learning, thinking, problem-solving

If hungry, opens mouth when he sees breast or bottle
Looks at her hands with interest

Movement/Physical Development Milestones

Holds head steady without support when you are holding him
Holds a toy when you put it in his hand
Uses his arm to swing at toys
Brings hands to mouth
Pushes up onto elbows/forearms when on tummy

6 months

Your Baby By Six Months

Social/Emotional Milestones

Knows familiar people
Likes to look at self in a mirror
Laughs

Language/Communication Milestones

Takes turns making sounds with you
Blows “raspberries” (sticks tongue out and blows)
Makes squealing noises

Cognitive Milestones (learning, thinking, problem-solving)

Puts things in her mouth to explore them
Reaches to grab a toy she wants
Closes lips to show she doesn’t want more food

Movement/Physical Development Milestones

Rolls from tummy to back
Pushes up with straight arms when on tummy
Leans on hands to support herself when sitting

9 months

Your Baby By Nine Months

Social/Emotional Milestones

Is shy, clingy, or fearful around strangers
Shows several facial expressions, like happy, sad, angry, and surprised
Looks when you call her name
Reacts when you leave (looks, reaches for you, or cries)
Smiles or laughs when you play peek-a-boo

Language/Communication Milestones

Makes a lot of different sounds like “mamamama” and “bababababa”
Lifts arms up to be picked up

Cognitive Milestones (learning, thinking, problem-solving)

Looks for objects when dropped out of sight (like his spoon or toy)
Bangs two things together

Movement/Physical Development Milestones

Gets to a sitting position by herself
Moves things from one hand to her other hand
Uses fingers to “rake” food towards himself
Sits without support

1 year

Your Baby By One Year

Social/Emotional Milestones

Plays games with you, like pat-a-cake

Language/Communication Milestones

Waves “bye-bye”
Calls a parent “mama” or “dada” or another special name
Understands “no” (pauses briefly or stops when you say it)

Cognitive Milestones (learning, thinking, problem-solving)

Puts something in a container, like a block in a cup
Looks for things he sees you hide, like a toy under a blanket

Movement/Physical Development Milestones

Pulls up to stand
Walks, holding on to furniture
Drinks from a cup without a lid, as you hold it
Picks things up between thumb and pointer finger, like small bits of food

RED

If your child has any of the following:

Breathing very fast, too breathless to talk, eat or drink
Working hard to breathe, drawing in of the muscles below the ribs
Breathing that stops or pauses
A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)
Drooling more than normal and struggling to swallow their own spit
Is pale, blue, mottled and/or unusually cold to touch
Difficult to wake up, very sleepy or confused
Weak, high-pitched, continuous cry or can’t be settled
Has a fit (seizure)
Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red or amber features)
Has a rash that does not go away with pressure (the glass test)

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999 - consider using ‘What 3 words’ to best describe location to ambulance service

AMBER

If your child has any of the following:

Breathing a bit faster than normal or working a bit harder to breathe
A harsh noise as they breathe in (stridor) only when upset
Dry skin, lips or tongue
Not had a wee or wet nappy in last 8 hours
Poor feeding in babies (less than half of their usual amount)
Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
Is 3-6 months old with temperature 39^oC or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
Temperature of 38^oC or above for more than 5 days or shivering with fever (rigors)
Temperature less than 36°C in those over 3 months
Getting worse and I am still worried

You need to contact a doctor or nurse today.

Please contact your GP surgery or call NHS 111 - dial 111.

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

AMBER

Green

If your child has none of the above

Watch them closely for any change and look out for any red or amber symptoms
Additional advice is also available for families for help cope with crying in otherwise well babies
If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111.

Advice and Guidance

Self care and Prevention

What are the symptoms of croup?

A cough. The cough is usually harsh and barking. This ‘croupy cough’ is due to inflammation and swelling of the vocal cords in the voice box (larynx).
Noisy breathing. The infection can narrow the voice box (larynx) and windpipe (trachea) and cause an extra noise called a stridor. This noise is normally heard on breathing in.
Breathing may become difficult if the narrowing becomes worse.
Your child may also have a runny nose, hoarse voice, sore throat, high temperature (fever), general aches and pains and be off their food. Croup may follow a cold but can also appear without any earlier illness.
The symptoms of croup appear worse at night. A mild but irritating cough may persist for a further week or so.

How can I help my child?

Stay calm. This will help keep your child calm. Children with croup may become upset. Crying may make their symptoms worse.
Sit your child upright on your lap if their breathing is noisy or difficult. Let them find the most comfortable position.
Encourage your child to drink cool drinks regularly (little and often) to help soothe their throat and keep them hydrated.
If your child seems to be in pain or discomfort, you can give your child Paracetamol or Ibuprofen, following the instructions on the container.
If their temperature is high, dress them in cool, loose clothes (if any) and don’t use anything warmer than a sheet to cover them in bed.
Stay with your child or check him or her regularly. You need to know if the symptoms are getting worse.
Some people find that taking their child outside in the cool, fresh air helps to relieve their symptoms.
There is no evidence that steam inhalation helps. There is a risk of scalds if steam is used.
Do not give cough syrup. It is not recommended for children under 6 years. It can make children sleepy and does not help croup.

How is croup treated?

Your child may be given a steroid medicine called dexamethasone or prednisolone which can reduce airway swelling.
As croup is caused by a viral illness antibiotics are not needed.