FAQ: Croup in Infants and Older Babies

Sometimes a cough is just a cough, but other times it can be a sign of a more significant condition that may require medical treatment. Croup is an inflammation of the upper airways that can cause your young child to cough with a barking sound. Find out more about what croup is, what its symptoms are, and how it can be treated.

What Is Croup and What Causes It?

Croup is an inflammation of the larynx (voice box), trachea (windpipe), and bronchi (bronchial tubes) that is quite common in children as young as 3 months and as old as 5 years. The inflammation causes these passageways to narrow, which can make breathing more difficult. Although croup most commonly affects children between 3 months and 5 years old, parents often ask, can newborns get croup? Yes, it is possible for newborns and infants under 6 months to develop croup, though it's less common. This leads some parents to wonder, why is croup rare in babies under 6 months? One reason is that very young infants may have maternal antibodies that offer some protection, but they're still susceptible to the virus causing croup. Therefore, while it's less common, can a newborn get croup? The answer is yes, so it's important to recognize the signs regardless of your child's age. 

Croup is most often caused by the parainfluenza virus, which is more likely to spread during the fall and winter. Your child can catch the virus by coming into contact with another infected child. Just like other respiratory viruses, it’s passed through contact with droplets, so when your child touches their nose or mouth, there's a chance they may get the virus. 

Although this infection can be uncomfortable for your little one, croup typically lasts from three to five days and can often clear up without treatment from your baby’s healthcare provider. If it does linger any longer or if your child has a more severe bout, take them to the provider for diagnosis and treatment.

Croup Symptoms and Typical Timeline

Croup symptoms usually develop over a few days and can worsen at night.

Early signs (may resemble a cold):

• Runny or stuffy nose

• Mild cough.

Typical symptoms (days 3–5):

• Barking cough, often worse at night or during crying, coughing, agitation, and anxiety

• Stridor: a high-pitched, squeaky sound when breathing in

• A hoarse/labored voice

• Fever (variable)

• Rapid or heavy breathing.

Duration: Most cases resolve within 3–5 days without medical treatment.

How Can You Treat Croup at Home?

Since croup is caused by a virus, there's no specific at-home treatment for it. It can’t be treated with antibiotics, which are used to treat bacterial infections but aren't effective for viral infections. 

Experts also recommend avoiding over-the-counter medicines like cough syrup, as these won't work and may be unsafe. 

When your child has croup, focus on keeping them comfortable and calm. Agitation and crying can make symptoms worse, as they may cause the airway to tighten even more. Here are some things you can try: 

• Comfort strategies: Reading or singing to them, hugging them, offering a favorite toy or blankie, speaking in a soft, soothing voice

• Use a cool-mist humidifier to ease breathing

• Offer plenty of fluids to prevent dehydration

• Fever management (a fever of 100.4 degrees Fahrenheit or higherfor children older than 6 months): infant acetaminophen or ibuprofen, after consulting your healthcare provider.

Always check with the provider when your baby is 3 months old or younger and has a fever. During a fever, make sure your child is getting lots of fluids so they don't become dehydrated.

In the past, parents may have followed the advice to bring their child into a steamy bathroom or to take them outside for moist night air. Though some parents find this to be helpful, there is no actual evidence that this is effective in treating croup.

Croup in Newborns and Infants (<6 Months)

While croup is less common in babies under 6 months, it can still occur. Very young infants may have some protection from maternal antibodies, but they are still vulnerable to the virus that causes croup.

Key considerations for newborns and infants:

• Symptoms that need emergency care:

  • Struggling to breathe, grunting, or retractions (skin pulling in around ribs)

  • Skin, lips, or tongue turning blue, grey, or pale

  • Drooling or difficulty swallowing

  • Extreme sleepiness, lethargy, or difficulty waking.

• Mild cases—home management:

  • Keep your baby calm: agitation worsens breathing

  • Use a cool-mist humidifier in the room

  • Offer frequent breast milk or formula

  • Gentle soothing: soft voice, rocking, or favorite blanket.

When to Contact Your Healthcare Provider?

Contact your baby’s healthcare provider if:

• Symptoms persist longer than 5 days or worsen

• Fever is high or continues beyond a few days

• Your child has difficulty feeding

• Symptoms are severe or unusual for your child.

To make a diagnosis, the provider may observe how your child breathes, listen to their chest, and examine their throat. In some cases, the provider may order an X-ray to rule out the possibility of another condition. 

If croup is diagnosed, your child’s healthcare provider may prescribe one of the following medications: 

• A steroid, which helps reduce the airway swelling. After a dose, your child may begin to feel better in a matter of hours. 

• Epinephrine, which can also reduce inflammation. This may be given with a nebulizer so that your child inhales the medication, resulting in quick relief. 

In very severe cases, if your child is having breathing difficulties, the provider may recommend your little one be hospitalized until their breathing improves. 

When Should You Take Your Child to the ER?

Croup can cause your child’s airway to swell and narrow, which can make breathing difficult. Difficulty breathing may also result in your child stopping eating and drinking. They may even become too tired to cough. 

If you see the following, take your child to the emergency room right away: 

• They struggle to breathe 

• They breathe faster than normal 

• They make a whistling sound (stridor) when they inhale or exhale, even when they aren't crying or agitated 

• Swallowing is difficult or they drool excessively 

• They have trouble speaking 

• They are very sleepy or fatigued, or even anxious 

• Their skin looks blue around the nose, mouth, or fingernails 

For example, if you have a 3 year old struggling to breathe, it's crucial to seek immediate medical attention. 

The Bottom Line

Croup may be an uncomfortable childhood illness, but in time it will go away. In the meantime, all you can do is comfort your little one while you wait for the infection to pass and see their healthcare provider if the condition worsens. In typical cases, a child will be back to their usual self in less than a week. 

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