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This Care Guide Covers:

  • Infection of the voicebox (larynx) caused by a virus
  • The croupy cough is tight, low-pitched, and barky (like a barking seal)
  • The voice or cry is hoarse (called laryngitis)
  • Some children with severe croup get a harsh, tight sound while breathing in. This is called stridor.

If not, see these topics
  • It doesn't sound like croup. See COUGH.
  • Tight purring sound when breathing out. See WHEEZING.
View First Aid Advice
  • First Aid Advice For Stridor
  • Harsh sound with breathing in) or for Nonstop Coughing:

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First Aid - Croup with Stridor
First Aid - Croup with Stridor

When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • Severe trouble breathing (struggling for each breath, constant severe stridor)
  • Passed out or stopped breathing
  • Lips or face are bluish when not coughing
  • Croup started suddenly after bee sting, taking a medicine or allergic food
  • Drooling, spitting or having great trouble swallowing (Exception: drooling due to teething)
  • You think your child has a life-threatening emergency
Call Your Doctor Now (night or day) If
  • Caution: For any stridor or trouble breathing, see FIRST AID
  • Stridor (harsh sound with breathing in) is heard now
  • Your child looks or acts very sick
  • Choked on a small object that could be caught in the throat
  • Trouble breathing (Exception: present only when coughing)
  • Lips or face have turned bluish during coughing
  • Ribs are pulling in with each breath (retractions)
  • Can't bend the neck forward
  • Severe chest pain
  • Age less than 1 year old with stridor
  • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
  • Fever over 104° F (40° C)
  • Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen.)
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
  • Had croup before that needed Decadron
  • Stridor (harsh sound with breathing in) occurred but not present now
  • Nonstop coughing
  • Age less than 1 year old with a croupy cough
  • Earache OR ear drainage
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Coughing causes vomiting 3 or more times
  • Croup is a frequent problem (3 or more times)
  • Barky cough lasts more than 14 days
Parent Care at Home If
  • Mild croup with no complications
Causes & Health Information

Stridor: A Complication of Croup


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  1. What You Should Know:
    • Most children with croup just have a barky cough.
    • Some have tight breathing (called stridor). 
    • Coughing up mucus is very important. It helps protect the lungs from pneumonia.
    • We want to help a productive cough, not turn it off.
    • Here is some care advice that should help.
  2. Humidifier:
    • If the air in your home is dry, use a humidifier.
    • Reason: Dry air makes croup worse.
  3. Homemade Cough Medicine:
    • Goal: Decrease the irritation or tickle in the throat that causes a dry cough.
    • AGE 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 ml). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
    • AGE 1 year and older: Use HONEY ½ to 1 teaspoon (2-5 ml) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup.
    • AGE 6 years and older: Use COUGH DROPS to coat the sore throat. If you don't have any, you can use hard candy.
  4. Non-Prescription Cough Medicine (DM):
    • Non-prescription cough medicines are not advised. Reason: No proven benefit for children and not approved under 4 years old. (FDA 2008.)
    • Honey has been shown to work better for coughs. (Caution: Do not use honey until 1 year old).
    • If age over 4 years old, you might decide to use a cough medicine. Choose one with dextromethorphan (DM). It's present in most non-prescription cough syrups.
    • When to Use: Give only for severe coughs that interfere with sleep or school.
    • DM Dose: See Dose Table. Give every 6 to 8 hours as needed.
  5. Coughing Fits or Spells:
    • Breathe warm mist (such as with shower running in a closed bathroom).
    • Give warm clear fluids to drink. Examples are apple juice and lemonade. Don't use before 3 months of age.
    • Amount. If 3 - 12 months of age, give 1 ounce (30 ml) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed.
    • Reason: Both relax the airway and loosen up any phlegm.
  6. Fluids:
    • Try to get your child to drink lots of fluids.
    • Goal: Keep your child well hydrated.
    • It also will thin out the mucus discharge from the nose.
    • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
  7. Fever:
    • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
    • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
    • For babies, dress lightly. Don't wrap in too many blankets. Reason: Can make the fever higher.
  8. Sleep Close By to Your Child:
    • Sleep in the same room with your child for a few nights.
    • Reason: Stridor can start all of a sudden at night.
  9. Calm Your Child if He or She has Stridor:
    • Crying or fear can make stridor worse.
    • Try to keep your child calm and happy.
    • Hold and comfort your child.
    • Use a soothing, soft voice.
    • For a few days, give in more than usual to his or her demands.
  10. Avoid Tobacco Smoke:
    • Tobacco smoke makes croup much worse.
  11. Return to School:
    • Your child can go back to school after the fever is gone.
    • Your child should also feel well enough to join in normal activities.
    • For practical purposes, the spread of croup and colds cannot be prevented.
  12. What to Expect:
    • Most often, croup lasts 5 to 6 days and becomes worse at night.
    • The croupy cough can last up to 2 weeks.
  13. Call Your Doctor If:
    • Stridor (harsh raspy sound) occurs
    • Croupy cough lasts more than 14 days
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/1/2012

Last Revised: 1/13/2013

Content Set: Child Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.