Croup

Advice for parents / carers

What is croup?

Croup can be caused by several viruses which affect the upper airways including the voice box (larynx), windpipe (trachea) and lungs (the bronchi) causing them to swell and become narrower. It usually affects babies and young children between the ages of 6 months and 6 years old. Some children have croup 2 or more times in their childhood.

What are the symptoms of croup?

Your child may have:

  • 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 symptoms. The inflammation 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
  • Other symptoms: may include a runny nose, hoarseness and a sore throat. Croup may follow a cold but can also appear without any earlier illness. Children may also experience a high temperature (fever), general aches and pains, and be off their food
  • The symptoms of croup appear worse at night. They usually peak after 1 to 3 days and then improve. A mild but irritating cough may persist for a further week or so

When should you worry?

If your child has any of the following:

  • Going blue around the lips
  • A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)
  • Pauses in their breathing (apnoeas) or an irregular breathing pattern
  • Too breathless to talk / eat or drink
  • Becoming drowsy (excessively sleepy)
  • Drooling and has difficulty swallowing saliva
  • Becomes pale, mottled and feels abnormally cold to touch
  • Becomes extremely agitated (crying inconsolably despite distraction), confused or very drowsy (difficult to wake)
  • Develops a rash that does not disappear with pressure (the ‘Glass Test’)
  • Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features) 

You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Has laboured/rapid breathing or they are working hard to breathe, drawing in of the muscles below their lower ribs, at their neck or between their ribs (recessions)
  • A harsh noise when they breathe in (stridor) present only when they are upset
  • Seems dehydrated (sunken eyes, drowsy or no urine passed for 12 hours)
  • Is 3 to 6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations)
  • Seems to be getting worse or if you are worried

You need to contact a doctor or nurse today

Please ring your GP surgery or call NHS 111 - dial 111

We recognise that during the current COVID-19 crisis, at peak times, access to a health care professional may be delayed. 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, then consider taking them to your nearest A&E

If none of the above features in the red or amber boxes above are present

Additional advice is also available to young families for coping with crying of well babies.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – (dial 111), or contact your local community pharmacist

  • Stay calm in order to reassure your child. Children with croup may become distressed and 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 them paracetamol or ibuprofen liquid, following the instructions on the bottle
  • 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 on them regularly as 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
  • It used to be thought that steam inhalation was helpful but there is no evidence to support this 
  • Do not give cough syrup. It is not recommended for children under 6 years, can make children drowsier and shows no benefit in treating croup

  • 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 and so antibiotics are not needed. 

You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

All community pharmacies across England are required to be Healthy Living Pharmacies. This means that they are able to offer advice about a range of healthy living matters which includes eating a healthy diet. They can provide information leaflets and give parents/carers and young people more information about other organisations that might be able to also help them with healthy eating.

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Sound advice

  1. Visit a pharmacy if your child is ill, but does not need to see a GP.
  2. Remember that if your child's condition gets worse, you should seek further medical advice immediately.
  3. Help your child to understand - watch this video with them about going to the pharmacy.

For information on common childhood illnesses go to What is wrong with my child?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns, or to the Community Paediatricians, or the child and adolescent mental health services.

 

Contact your local Health Visiting Team:

Bradford Health Visitors or call - 01274 221223

Wakefield Health Visitors or call - 01924 310130

Craven Health Visitors or call - 01423 544265

Leeds Health Visitors or call - 0113 843 5683

Calderdale Health Visitors or call - 030 0304 5555 (local rate number)

Kirklees Health Visitors or call - 030 0304 5555 (local rate number)

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

  • Breastfeeding, weaning and healthy eating
  • Exercise, hygiene and safety
  • Your child’s growth and development
  • Emotional health and wellbeing, including postnatal depression
  • Safety in the home
  • Stopping smoking
  • Contraception and sexual health
  • Sleep and behaviour management (including temper tantrums!)
  • Toilet training
  • Minor illnesses

For more information about what Health Visitors do: What does a health visitor do?

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.

 

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Contact your local school nursing team:

Bradford School Nurses01274 221203

Wakefield School Nurses01924 310130

Leeds School Nurses - 0113 843 5683

Calderdale School Nurses030 3330 9974 (local rate number)

Kirklees School Nurses0300 304 5555 (local rate number)

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:-

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

All children should be registered with a GP. Anyone in England can register for free with a GP surgery. You do not need proof of address or immigration status, ID or an NHS number.

How to find your local GP.

Sound advice

You have a choice of service:

  1. Doctors/GPs can treat many illnesses that do not warrant a visit to A&E.
  2. Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Please note, the online version of NHS 111 is only recommended for children over the age of five. If your child is under five years old, please phone 111.

NHS 111 can also direct you to your nearest urgent treatment centre (minor injuries unit or walk-in centre).

Find your local urgent treatment centre.

When to visit an urgent treatment centre.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as:

  • loss of consciousness
  • breathing difficulties
  • severe bleeding that cannot be stopped
  • major trauma such as road traffic collisions

If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  1. Many visits to A&E and calls to 999 could be resolved by any other NHS services.
  2. If your child's condition is not critical, choose another service to get them the best possible treatment.
  3. Help your child to understand – watch this video with them about going to A&E or riding in an ambulance

This guidance has been reviewed and adapted by healthcare professionals across West Yorkshire with consent from the Hampshire development groups.