Most croup cases are mild, but croup can be serious in younger kids and babies. Get immediate medical help if your child is having trouble breathing and swallowing, discoloration, retractions, and stridor.

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Did your child go to bed fine and wake up in the middle of the night with a barking, “croup-y” cough?

Croup is an infection of the upper airway.

You may notice that your little one is having difficulty breathing or is making a strange whistling noise when breathing in. This is called stridor, and it can happen with serious cases of croup. It’s a sign that your child’s breathing may be obstructed by swollen tissues.

Here’s more about croup, how to recognize it, and why you should contact your doctor if it becomes severe.

While most cases of croup can be treated at home, go with your gut if you think things are more serious. You know your child best. For example, your little one may look particularly ill or fatigued. Or maybe they’re not acting like themselves all of a sudden.

Other emergency signs:

  • trouble breathing
  • fast breaths or labored breathing
  • retractions (when the skin between the ribs sucks inward while breathing)
  • discoloration around the mouth (pale/blue)
  • trouble swallowing
  • stridor or high-pitched noise when taking breaths

Dehydration is another danger that may go along with croup. Head to your local emergency department if your child hasn’t peed or has had very dark urine in the last 8 to 12 hours.

Other signs of dehydration include:

  • dry mouth
  • sunken eyes/no tears
  • extreme thirst
  • exhaustion

Croup is usually caused by a virus, specifically parainfluenza viruses. For this reason, it’s classified as infectious croup. However, many kids who are exposed to viruses that cause croup will only develop cold symptoms.

Those with smaller or more vulnerable airways may develop the characteristic cough. It happens when inflammation hits the voice box, windpipe, and bronchial tubes. As your child coughs, air passes through these swollen areas and it creates that low-pitched barking noise.

As far as timing goes, you may notice your child is sick in the fall or early winter months, which is when many viruses are in high gear.

Related: Is croup contagious?

At first, your child may be stuffy and have a slight cough. As time goes on, your child’s cough may get louder and sound like a barking seal. Again, this is due to the inflammation of the voice box, windpipe, and upper airways. Persistent coughing continues to irritate these tissues.

If you’re unsure, one of the most classic signs is that your child’s cough tends to worsen at night. The cough may even seem to come out of nowhere and be particularly bad when your child is crying, anxious, or agitated.

Other symptoms may include:

  • runny nose
  • fever
  • loud breathing
  • difficulty breathing
  • hoarseness or other voice changes

These symptoms generally last from 3 to 5 days, peaking around 2 to 3 days after the start of the initial virus.

Most children only get cold-like symptoms with the viruses that cause infectious croup. But younger kids and babies are more likely to deal with serious cases of croup. Why? Well, their airways are tiny, so any swelling may be more dangerous.

Around 3 percent of children in this age group (6 months to 3 years) will experience croup at one time or another. It’s somewhat common, so it’s a good idea to become familiar with the symptoms and potential complications.

Your child may also be at risk of developing a more severe case of croup if they have allergies, asthma, or other respiratory issues.

In fact, spasmodic croup is a condition that may impact children with existing respiratory issues. It’s marked by sudden-onset coughing that may or may not have any warning signs, like a stuffy nose or fever.

Even mild cases of croup can seem scary, especially when they crop up in the middle of the night and cause your child a lot of discomfort. In these moments, it’s important to stay calm and monitor your child’s breathing.

Beyond the cough itself, you’ll want to listen to the pace and overall feel of your child’s breaths to see if they become fast and/or shallow.

You may also hear stridor or other breath sounds that are abnormal for your child. Note these signs and any other symptoms so you can share them with your healthcare provider.

Observe your child as they breathe as well. If you see their chest/skin between the ribs suck in while breathing, these are retractions and are a sign that they’re having trouble breathing normally.

Discoloration of the lips and around the mouth — blue or simply pale — may mean low oxygen. This is a medical emergency. Difficulty swallowing or drooling are other warning signs that your little one’s airways are obstructed or inflamed and they need immediate medical help.

That high-pitched whistling sound you may hear when your child is inhaling is called stridor. This sound comes from your child’s voice box and may be a sign that the inflammation and swelling is making breathing difficult.

If the stridor seems mild, you may be able to help your child at home. Try:

  • Calming your child as much as possible. Crying and agitation can make stridor and cough worse. Hold your little one and speak in a soft voice, sing a lullaby, or offer a favorite lovey.
  • Humidifying the air by creating a steam room in your bathroom. Close the door and run your shower with hot water.
  • Alternatively, try going outside into cooler air or standing by an open refrigerator door. You may also try using a humidifier in your child’s room.

If these measures don’t help and you still hear your little one struggling with stridor, don’t hesitate to contact your doctor or head to the emergency room. You may need steroids or special breathing treatments to calm the inflammation.

Mild cases of croup can be treated with rest, fluids, and over-the-counter pain and fever medications (acetaminophen, ibuprofen).

Only a small percentage of kids will develop severe cases. When croup is more serious, your doctor may first prescribe steroids to help with the swelling in your child’s airway.

In particularly severe cases, your child may need a special breathing treatment containing epinephrine. This medication addresses the swelling immediately and may or may not be combined with oxygen therapy.

Regardless, your child’s doctor may ask you to stay overnight for observation, especially if your child has low oxygen levels (hypoxia).

Unfortunately, there’s no trick to preventing croup. It may develop in younger children and babies as a virus progresses because their airways are small.

That said, you can lower your little one’s chances of getting sick by practicing good hygiene, especially during cold and flu season.

  • Wash your child’s hands frequently, especially when you’re in contact with people who may be sick.
  • Instruct them to avoid touching their eyes, nose, and mouth when their hands may be dirty.
  • Keep your child away from anyone you think may be sick whenever possible.
  • Keep your child’s vaccinations current — including diphtheria and Haemophilus influenza type b (Hib). These vaccinations cover rare, but serious upper airway infections.

Related: Everything you need to know about vaccinations

Croup and the resulting signs of breathing difficulty can come on quite suddenly. If your child has a loud cough but is taking normal breaths, stay calm and try a steam room to help soothe them.

But if you notice your little one is struggling to breathe, has stridor, or is otherwise acting abnormally, it’s time to act fast to get the medical help you need.