Toddler · Respiratory
Croup at Home or Hospital?
Mild croup almost always settles at home; moderate croup needs a single dose of oral dexamethasone (often by phone prescription); severe croup is A&E. Plus how to spot the rare but serious epiglottitis impostor.
Last reviewed 28 May 2026
Croup at home vs hospital
Can I treat my child's croup at home?
Features present
What croup actually is — in plain English
- Viral inflammation around the vocal cords and upper windpipe.
- Most common cause: parainfluenza virus. Also RSV, influenza, adenovirus.
- The voice box is narrow in small children — a millimetre of swelling matters more.
- Peak age: 6 months to 3 years (can occur up to 6).
- Peaks autumn / early winter.
- Hallmark sounds: barking cough + stridor (noise breathing IN) + hoarse voice.
- Almost always WORSE at night (1-3am classic).
- Typical course: 5-7 days. Peaks day 2-3.
Home care for mild croup
- Stay calm. Panic worsens it because the airway tightens with crying / agitation.
- Sit upright in your lap or against a pillow. Avoid lying flat.
- Cool fresh air can help — open a window for 5-10 min. Old advice about hot steamy bathrooms has weak evidence (some kids benefit, some don’t).
- Paracetamol or ibuprofen for fever or general discomfort.
- Fluids — sips often.
- Cuddle and distract — calm presence reduces airway agitation.
- Sleep nearby for the first night or two — you’ll hear changes.
- Don’t give cough syrups — NHS / NICE advise against in under-6s.
Dexamethasone — the game changer
- NICE / RCH recommend a single oral dose of dexamethasone (0.15 mg/kg) for ALL moderate croup — and increasingly for mild too.
- Acts within 1-2 hours; effect lasts 24-72 hours.
- Reduces hospital stays, reduces return visits, reduces need for adrenaline nebulisers.
- Often prescribed by GP / out-of-hours over the phone or at brief A&E visit.
- Standard care for over 20 years — very safe at this single low dose.
- Alternative if dexamethasone unavailable: prednisolone 1 mg/kg (less evidence but reasonable).
Hospital signs — A&E / 999 now
- Stridor at rest (when child is calm).
- Severe chest indrawing or recession.
- Fast breathing for age, even at rest.
- Child very distressed, agitated, restless.
- Blue or grey lips / tongue.
- Drowsy, exhausted, hard to wake (late sign).
- Drooling / can’t swallow / sitting forward to breathe (NOT typical croup — possible epiglottitis).
- Pause in breathing.
- Worsening despite home measures.
Educational tool only — not medical advice. Stridor at rest, distress, or blue lips = emergency. Drooling + sitting forward = epiglottitis (rare but emergency). Companion clinical tool: Westley croup score.
What does this mean?
Croup is one of the most distinctive and dramatic-sounding childhood illnesses — and one where the gap between “manage at home with reassurance” and “needs urgent treatment” is the widest. Getting the assessment right matters because most croup is benign and resolves in days, but a small percentage of children develop life-threatening upper airway obstruction within hours. The disease is viral inflammation around the vocal cords and upper windpipe (laryngotracheobronchitis), usually parainfluenza. Because a small child’s airway is so narrow to begin with, a millimetre of swelling at the vocal cords causes the distinctive sound profile: barking, seal-like cough + hoarse voice + stridor (a high-pitched noise on the in-breath). It almost always strikes hardest at night — the classic 1-3am wake-up — because of circadian airway diameter changes and lying flat. The PARENT’S key decision is the severity assessment. MILD croup: barking cough and hoarse voice but no stridor at rest, no indrawing, child not distressed. Home care, calm upright positioning, cool fresh air, paracetamol if uncomfortable. MODERATE croup: stridor at rest, chest indrawing, but oxygen-pink and alert. Same-day GP / 111 / A&E for a single dose of oral dexamethasone — the game-changer in croup management for the last 20+ years, which significantly reduces severity, hospital admission, return visits, and need for adrenaline nebulisers. SEVERE croup: stridor at rest, severe distress, exhaustion, or any colour change — A&E / 999 for dexamethasone + nebulised adrenaline + observation. LIFE-THREATENING: blue/grey, drowsy, exhausted — 999 NOW, do not drive. One impostor to know: epiglottitis — a bacterial infection of the epiglottis (Haemophilus influenzae type b, much rarer since the Hib vaccine but not zero). Looks similar but presents with drooling, sitting forward to breathe, refusing to swallow, higher fever, and usually NO barking cough. This is an airway emergency — do NOT look in the throat (can trigger total obstruction), keep the child upright, call 999. A few myths worth dropping: (1) The old advice to sit in a steamy bathroom has weak evidence — cool fresh air works just as well or better. (2) Cough syrups are not recommended in under-6s — no benefit, real risks. (3) Antibiotics don’t help croup (it’s viral). (4) Parental panic genuinely makes croup worse because crying / agitation tightens the airway further — the most useful thing you can do alongside seeking medical care is project calm.
Can I treat my child's croup at home?
Yes for mild croup — barking cough, hoarse voice, no stridor at rest, no significant chest indrawing, child alert and settled. The big intervention that’s changed croup care over the last 20 years is oral dexamethasone for moderate or worse — a single dose that dramatically shortens the illness, often given by phone prescription from GP / NHS 111 / out-of-hours.
What is croup, in plain English?
Viral inflammation around the vocal cords and upper windpipe. Most often parainfluenza virus. The voice box is narrow in small children — a millimetre of swelling matters more.
- Peak age: 6 months to 3 years (can occur up to 6).
- Peak season: autumn / early winter.
- Hallmark sounds: barking cough + stridor (noise breathing IN) + hoarse voice.
- Almost always worse at night (classic 1-3am).
- Typical course: 5-7 days. Peaks day 2-3.
How do I tell mild from moderate from severe croup?
- Mild: barking cough, hoarse voice, occasional stridor when crying/upset, no chest indrawing, child settled and alert.
- Moderate: stridor at rest, mild-moderate chest indrawing, child a bit anxious but consolable.
- Severe: stridor at rest, severe chest indrawing or recession, very distressed / restless / exhausted.
- Life-threatening: drowsy, hard to wake, blue/grey lips, weak respiratory effort, almost silent chest (run out of energy to draw breath).
What can I do at home for mild croup?
- Stay calm. Panic worsens it — airway tightens with crying/agitation. The most useful thing you can do is project calm.
- Sit upright in your lap or against pillows. Avoid lying flat.
- Cool fresh air — open a window for 5-10 minutes. Old hot-steamy-bathroom advice has weak evidence and burn risk.
- Paracetamol or ibuprofen for fever or discomfort.
- Fluids in sips.
- Cuddle and distract.
- Sleep nearby the first night or two — you’ll hear changes.
- No cough syrups — NHS / NICE / AAP advise against in under-6s.
Dexamethasone — the game-changer
Single oral dose of dexamethasone (0.15 mg/kg, max 12 mg) is the standard treatment for all moderate croup, and increasingly for mild too. Works within 1-2 hours; effect lasts 24-72 hours. Reduces severity, hospital stays, return visits, and need for adrenaline nebulisers. Often prescribed:
- By phone consult from GP / NHS 111 / out-of-hours.
- At brief A&E visit (often discharged within 2-3 hours after observation).
- Alternative if dex unavailable: prednisolone 1 mg/kg (slightly less evidence but reasonable).
Very safe at this single low dose — over 20 years of evidence.
When is it definitely hospital?
- Stridor at rest (even when calm) — A&E.
- Severe chest indrawing or recession.
- Fast breathing for age, even at rest.
- Child very distressed, agitated, restless.
- Blue or grey lips / tongue — 999.
- Drowsy, exhausted, hard to wake — 999 (late sign of respiratory exhaustion).
- Drooling / sitting forward / refusing to swallow — possible epiglottitis — 999.
- Worsening despite home measures.
The epiglottitis impostor — what to know
Bacterial infection (classically Haemophilus influenzae type b) of the epiglottis. Rare since Hib vaccine but still happens. Looks similar to croup at first glance but distinguished by:
- Drooling — can’t swallow saliva.
- Sitting forward to breathe (the “tripod position”).
- Higher fever than typical croup.
- Refusing to swallow.
- No barking cough usually — quieter, more anxious.
- Sudden severe progression.
AIRWAY EMERGENCY. Don’t look in the throat (can trigger total obstruction). Keep upright. 999.
Different scenarios
Scenario 1: 18-month-old, runny nose all day, woke at 2am with barking cough, hoarse, no other features
Classic mild croup. Sit upright, open window 5 min, paracetamol if uncomfortable, calm presence. Likely settles in 30-60 min. Watch overnight for any change.
Scenario 2: 2-year-old with barking cough, occasional stridor when crying, mild chest indrawing when distressed
Mild-to-moderate. Phone GP / NHS 111 next morning (or out-of-hours if night). Dexamethasone often prescribed by phone. Continue home measures meantime.
Scenario 3: 3-year-old with stridor at rest, anxious, chest indrawing visible
Moderate croup. A&E now. Dexamethasone + observation; possible nebulised adrenaline if severe. Most children discharged after 2-3 hours of observation post-treatment.
Scenario 4: Child becomes drowsy and quiet after a noisy night
ALARM — quiet child after noisy croup can mean exhaustion and impending respiratory failure. 999 NOW.
Scenario 5: Drooling, sitting forward, refusing to swallow, high fever
Possible epiglottitis. 999. Don’t look in mouth, don’t lay flat, don’t give anything by mouth.
Care guidance — getting through a croup episode
- Project calm. Your settled energy reduces airway agitation.
- Sit upright — in your lap is often easiest. Avoid lying flat.
- Cool fresh air when possible.
- Fluids in sips. Avoid fizzy drinks (can trigger coughing).
- Cuddle, soft voice, gentle distraction.
- Sleep nearby for the first 1-2 nights.
- Track the child, not the cough. A bit of barking is fine; severe distress or any colour change is not.
- Follow-up after dexamethasone — effect lasts 24-72 hours; symptoms can return as it wears off.
- Don’t use cough syrups, vapour rubs, or sedatives.
Common myths — debunked
- “Steam from a hot bath cures croup” — weak evidence; cool fresh air works at least as well; burn risk with steam.
- “Croup needs antibiotics” — no, it’s viral.
- “You should give a cough syrup” — not in under-6s. The barking is from airway inflammation, not lung mucus.
- “If it’s quiet now it’s getting better” — quiet child after noisy croup can mean respiratory exhaustion. Watch responsiveness.
- “Croup is contagious to adults” — the virus is, but adults get laryngitis not croup (adult airway is wider).
Sources
- NICE CKS. Croup. 2021.
- RCH Melbourne. Clinical Practice Guidelines: Croup (Laryngotracheobronchitis).
- Bjornson CL, Johnson DW. Croup in children. CMAJ 2013.
- Cochrane Database. Glucocorticoids for croup in children.
- NHS. Croup — symptoms and treatment.
- Westley CR, et al. Nebulized racemic epinephrine by IPPB for the treatment of croup. Am J Dis Child 1978 (origin of Westley score).
Frequently asked questions
What is croup and what causes it?
Croup is viral inflammation of the upper airway — specifically the vocal cords and immediate windpipe (laryngotracheobronchitis). Causes the distinctive barking, seal-like cough + hoarse voice + stridor (noise breathing in). Most often parainfluenza virus; also RSV, influenza, adenovirus, coronaviruses. Peak age 6 months to 3 years (can occur up to 6). Peaks autumn and early winter. Typical course 5-7 days; almost always worse at night (1-3am classic).
Can I treat croup at home?
Yes for MILD croup — barking cough, hoarse voice, but no stridor at rest, no chest indrawing, child settled and alert. Home care: stay calm (panic worsens it), sit upright, cool fresh air can help (open window 5-10 min), paracetamol if feverish, fluids in sips. NOT at home if stridor at rest, indrawing, distress, drooling, or blue lips. Moderate croup deserves a same-day phone call for dexamethasone — it dramatically shortens the illness.
When should I go to A&E for croup?
Go to A&E or call 999 if any of: STRIDOR AT REST (noise on breathing in even when calm), severe chest indrawing or tugging between ribs, child very distressed or restless, drowsy or hard to wake, blue or grey lips/tongue, drooling + sitting forward (possible epiglottitis, not croup), pausing in breathing, no improvement despite home measures. 999 if blue, exhausted, can't talk, or severely distressed — don't drive.
Does steamy bathroom help croup?
Mixed evidence. Some children improve with steam, some don't, and trial evidence is weak. Cool fresh air (open window 5-10 minutes) has at least as good anecdotal effect as steam, and is easier and safer (steam burns are a real risk in toddlers). RCH Melbourne guideline: cool air for mild croup; don't insist on steam if your child doesn't tolerate it. Don't use steam vaporisers near small children — burn risk.
What is dexamethasone and does my child need it?
Single oral dose of corticosteroid (dexamethasone 0.15 mg/kg, max 12 mg) — the game-changer in croup management. Recommended for ALL MODERATE croup (stridor at rest, chest indrawing) and increasingly for MILD croup too. Acts within 1-2 hours; effect lasts 24-72 hours. Reduces severity, hospital stays, return A&E visits, and need for adrenaline. Often given by phone consult from GP / NHS 111 / out-of-hours; or single brief A&E visit. Very safe at this single dose. Alternative if dex unavailable: prednisolone 1 mg/kg (less evidence).
What is the Westley croup score?
Clinical severity score for croup, used by clinicians. Five components: level of consciousness, cyanosis, stridor at rest, air entry, retractions/recession. Scores 0-17. 0-2 = mild; 3-5 = moderate; 6-11 = severe; 12+ = impending respiratory failure. Parents don't need to score — but the components match the features the tool above checks. See /calculators/croup-westley for the formal version used by clinicians.
How is croup different from a normal cough?
The SOUND is distinctive: barking, seal-like, harsh — not the soft wet cough of a cold or the deep chest cough of bronchitis. Often accompanied by a hoarse voice (laryngitis), and in moderate-to-severe croup, a high-pitched whistling noise on the IN-breath (stridor). Almost always worse at night. Sudden onset — child often well at bedtime, wakes barking and noisy at 1-3am. See /calculators/baby-cough for the broader cough recognition.
How long does croup last?
Usually 3-7 days total. Pattern: cold-like symptoms for 1-2 days, then the barking cough hits typically on day 2-3 (often at night), worst that night, then gradually improves over 3-5 days. Recurrent croup (same child gets it multiple times) is common — they grow out of it as the airway gets larger. Persistent stridor or recurrent severe episodes warrant ENT referral (rule out structural cause — subglottic stenosis, laryngomalacia).
Can adults get croup?
Very rare in adults. Adult airway is wide enough that a millimetre of swelling at the vocal cords doesn't cause obstruction. Adults with parainfluenza or similar virus usually get a hoarse voice (laryngitis) without the croup picture. Adult-onset persistent stridor needs urgent ENT review — different differential entirely (vocal cord paralysis, tumours, foreign body).
Should I give cough syrup for croup?
No — NICE / NHS / AAP all advise AGAINST cough syrups in under-6s. No evidence of benefit, real safety risks (overdose, sedation, breath suppression). The barking cough is from airway inflammation, not lung mucus — cough syrups don't address it. The treatment that actually works for moderate croup is oral dexamethasone.
Is the croup vaccine? Can I prevent it?
No specific croup vaccine — the parainfluenza virus that causes most croup doesn't have a vaccine. Routine childhood vaccines (Hib, pneumococcal, influenza) reduce the risk of croup-mimicking conditions (epiglottitis, severe bronchiolitis, secondary bacterial infection). Hand-washing, avoiding sick contacts where possible, and good general health. Most children will get croup at least once between 6 months and 5 years — it's not preventable to a meaningful degree.
What is epiglottitis and how is it different?
Bacterial infection (Haemophilus influenzae type b classically) of the EPIGLOTTIS — the flap that closes the windpipe when swallowing. Now rare since Hib vaccine but still happens. Looks similar to croup but: (1) DROOLING (can't swallow saliva); (2) SITTING FORWARD to breathe; (3) HIGHER FEVER; (4) NO barking cough usually; (5) Sudden severe progression. AIRWAY EMERGENCY — do NOT look in the throat (can trigger total obstruction), keep upright, 999. Hib vaccine has dropped this from ~5 cases per 100,000 children to ~0.1.
Why does croup get worse at night?
Several reasons: (1) Circadian narrowing of the airway diameter at night; (2) Lying flat increases mucus pooling and airway tightening; (3) Lower endogenous cortisol overnight (cortisol normally reduces airway inflammation); (4) Reduced parental availability for distracting / soothing in the dark hours leads to escalating anxiety in the child. Classic croup timing is 1-3am. By dawn it's often noticeably better. Expect this and plan to be near them overnight.
Can my baby get croup if they're under 6 months?
Less common. Under 6 months, the airway is still very small and croup-like symptoms in a baby this age need a lower threshold for medical review — could be bronchiolitis (more typical at this age) or other respiratory issue. Stridor in a baby under 3 months particularly needs assessment (could be congenital — laryngomalacia, subglottic stenosis, vocal cord paralysis).
My child gets croup over and over — is that normal?
Recurrent croup is common; some children have several episodes between 6 months and 5 years. If episodes are unusually frequent (4+ episodes in 6 months), particularly severe, or there's stridor between episodes — ENT referral. Possible causes: subglottic stenosis (congenital narrowing), gastro-oesophageal reflux contributing to airway inflammation, atopy / asthma overlap. Most children grow out of recurrent croup by age 6-7 as airway diameter increases.
How does this relate to other calculators on BumpBites?
Companion: /calculators/croup-westley for the clinical Westley score; /calculators/baby-cough for the broader cough type identifier; /calculators/baby-fever for the fever-decision tool; /calculators/pram-asthma for the asthma severity (overlap with viral wheeze); /calculators/pediatric-dose for paracetamol / ibuprofen dosing.