Health Insights · Paediatrics
Croup: a barking cough in young children
Croup is a viral illness that swells the upper airway, giving a harsh barking cough and noisy breathing. It sounds far worse than it usually is, it is nearly always worse at night, and keeping your child calm genuinely helps — because crying tightens the airway further.
Call 999 now if your child
- is making a harsh noise when breathing in while sitting still, not just when coughing or upset;
- is sucking in below the ribs, at the neck or between the ribs with each breath;
- looks pale, blue or grey, particularly around the lips;
- is restless and agitated, or unusually drowsy and difficult to rouse;
- is drooling, cannot swallow, or will not lie down and is sitting forward to breathe;
- goes quiet and still after being noisy — a tiring child can stop making noise, and that is more worrying, not less.
Keep your child upright and as calm as you can while you wait for help. Tower Bridge Hospital London is not an emergency service. The nearest emergency department is the Royal London Hospital, Whitechapel Road, London E1 1FR.
Recognising croup
Croup is most common in children between six months and three years, though it can occur up to about six. It usually appears a day or two after an ordinary cold, and is commonest in autumn and winter. The cough is typically much worse at night, often waking a child suddenly, and tends to be worse for the first two or three nights.
Most children are back to normal within 48 hours, though the cough can rumble on for a week or so.
What to do at home
- Stay calm and keep your child calm. This is the single most useful thing you can do. Distress makes the breathing noisier and the airway tighter. Sit them upright on your lap, hold them, read to them, keep the lights low.
- Sit them upright rather than laying them flat, and prop them up at night.
- Offer plenty of drinks in small amounts.
- Give paracetamol or ibuprofen at the dose on the packet if your child has a temperature or is uncomfortable. Use one at a time.
- Sleep nearby for the first couple of nights so you can hear them and respond quickly.
- Do not smoke anywhere in the home. Smoke irritates an already inflamed airway.
Steam is no longer recommended. Sitting a child in a steamy bathroom was advised for many years, but studies have not shown it to help, and children have been badly scalded by hot water and kettles while it was being tried. Taking a child outside into cold air has not been shown to work either. Calm, upright and comforted is the approach that has evidence behind it.
Treatment
Most children with croup are given a single dose of an oral steroid such as dexamethasone. It reduces the swelling in the airway, starts working within a few hours, and lasts a day or two — which is why one dose is usually all that is needed. If your child has been given it, you do not need to repeat it.
Antibiotics do not help, because croup is caused by a virus. Cough medicines and decongestants do not help either and are not suitable for young children.
A small number of children need to be observed in hospital, or given an inhaled treatment through a mask, if the airway swelling is more marked. That is a precaution rather than a crisis.
Expect it to come back for a couple of nights. A child who was well all day can wake barking again at 2am. That pattern is typical of croup and does not mean the treatment failed. What matters is how they are breathing between coughing bouts — settled and quiet at rest is reassuring; noisy at rest is not.
Book an appointment with us if
- the barking cough lasts more than about a week, or keeps returning over several weeks;
- your child has a high temperature that is not settling, or seems increasingly unwell;
- your child is under six months old and has croup symptoms;
- you would like your child examined, or want to talk through what to do next time.
We see children 7 days a week, usually the same day.
Private paediatric assessment for croup in East London
Croup causes a barking cough and sometimes noisy breathing, and mild croup usually settles, often helped by a single dose of steroid. Our private paediatric team and urgent care team can assess your child and treat croup. Call 999 if your child is struggling to breathe, has a persistent high-pitched noise breathing in, is drooling or unable to swallow, or is pale and drowsy. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.
Croup in London: common questions
When is croup an emergency?
Struggling to breathe, a constant harsh noise breathing in (stridor) at rest, drooling, or becoming pale or drowsy — call 999.
How is croup treated?
Mild croup often settles with calm and comfort; a single dose of steroid frequently helps and can be given after assessment.
How long does croup last?
The barking cough is usually worst for a night or two and settles over a few days; symptoms are often worse at night.
Can my child be seen the same day?
Yes — same-day private paediatric and urgent care appointments are available most days.
Seen today, not next week
Same-day appointments most days, 7 days a week, 9am–7pm, on Whitechapel Road.