Croup (falsk krupp in Swedish) is a swelling of the larynx that makes a child with a cold wake at night with a barking cough, hoarseness and a rasping sound when breathing in. It looks and sounds frightening but usually eases within fifteen minutes if you keep your child calm, sitting upright, in cool air. Call 112 if your child struggles to breathe at rest, the skin pulls in at the base of the throat with every breath, the lips turn blue or your child becomes drowsy.
Half past eleven at night, a one-year-old who was a little snuffly at bedtime wakes up sounding like a seal. Every breath in rasps, he is hoarse, he cries and gets worse from crying. It is croup, and the first thing the nanny or you feel is panic. It is understandable, and it is the first thing that has to go, because your child reads you. Here is what is happening in the body, what helps and where the line to the emergency department lies.
What it sounds and looks like
- A barking cough, like a dog or a seal. Unmistakable once you have heard it.
- Hoarseness. Your child sounds cracked when talking or crying.
- A rasping sound when breathing in, known as stridor. It is the sign that the airway is narrow.
- A sudden start at night, often after a day with a mild cold. At bedtime everything sounded normal.
- A mild fever sometimes, but your child is rarely very unwell otherwise.
- It gets better in the morning and often comes back the next night, for a couple of nights.
What to do at home, step by step
- Stay calm. Pick your child up, speak softly, hold them against you. Crying and fear make the swelling and the breathing worse. Your calm is the first treatment.
- Sit upright. Your child on your lap, upright, not lying down. Many children breathe more easily if they can lean against your shoulder.
- Cool air. Open the window wide or go out onto the balcony or into the courtyard with a blanket around your child. In winter in Stockholm this is quick and effective. In summer the freezer works: stand in front of the open door and breathe.
- Wait fifteen minutes. If the breathing is calmer, the cough less frequent and your child falls back asleep half sitting up, it is over for tonight.
- Something to drink in small sips once your child has calmed down. Raise the head end of the bed with a towel under the mattress.
- If it does not get better within half an hour, or if your child gets worse in the meantime: call 1177 (the national healthcare helpline), or 112 at the signs in the table below.
Steam in the bathroom is an old piece of advice that many people use. It has weak support in the research, but it is harmless and calms some children. Do it if cool air cannot be arranged, but prioritise the cool air.
When to call 112 and when to wait
| Call 112 or go to the emergency department | Wait at home in cool air |
|---|---|
| Difficulty breathing even at rest, between the coughing fits | Rasping only when your child coughs or cries |
| The skin pulls in at the base of the throat and between the ribs with every breath | The breathing settles on your lap within fifteen minutes |
| Blue or greyish colour around the mouth | Normal colour, rosy cheeks from crying |
| Your child is drowsy, has no energy to cry, hard to get a response from | Angry, scared, but alert |
| Drooling, cannot swallow, sits leaning forward with the mouth open, high fever | Swallows and drinks |
| No improvement after half an hour | Clearly better after fifteen minutes |
What the healthcare service does
At the emergency department or the vårdcentral (local health centre) they assess the breathing and give cortisone if needed, which reduces the swelling within a few hours, and sometimes a bronchodilator through a nebuliser if it is acute. Many children are sent home the same night with a clear improvement. Children who have had croup several times can be given cortisone to keep at home, to give according to the doctor's instructions at the next attack. Ask about it at your next appointment if your child has had it more than once. Antibiotics do not help. It is a virus.
The days after, and förskola
Croup is a cold with an extra night-time complication. During the day your child is usually fairly bright, hoarse and a little coughy. They can go back to förskola (municipal preschool, from age one) once they are fever free and have the energy to join in, as with any cold, but expect the next two or three nights to bring a repeat. Let your child sleep with the head end raised and cool air in the room, keep the window ajar and a blanket ready. There is no reason to wake your child to listen. You will hear the cough anyway.
Can it be prevented?
Not the individual infection, but the nights can be made a little better: a cool bedroom, air that is not too dry, the head end raised during a cold. Children who have had croup often get it a few more times until the airway has grown, and most stop at around three to five years. You do not need to worry that it is asthma or something chronic. It is a size of airway that your child grows out of.
How we do it with our families
All our nannies have been asked about croup, because it comes on evening sessions when you are out at dinner and your phone is in your bag. Our rule is simple: the nanny takes the child into cool air, sits them upright and rings you at the same time, on speakerphone. If it does not improve in fifteen minutes she calls 1177, and at signs of breathing difficulty at rest she calls 112 without waiting for you. We go through this at the first meeting with families who have children of croup age, and we ask you to write down where the blanket and the balcony keys are.
This text is general information and does not replace advice from BVC (the child health clinic every family is enrolled in), your vårdcentral or 1177. If you are worried about your child, call 1177. In an emergency, call 112.
Would you like a nanny who knows your child, knows what is normal for them and notices when something is different? Book a free first meeting with the nanny in your home.
Read more: Cough in children · Laboured breathing while your child sleeps · Colds in children · Evening and overnight babysitting
Frequently asked questions
What is croup?
A viral infection that causes swelling in the larynx and below the vocal cords, which narrows the airway. It gives a barking cough, hoarseness and a rasping sound when your child breathes in. It is most common in children between six months and three years, mostly in autumn and winter, almost always at night.
Why does it come at night?
The swelling gets worse when your child lies down, and at night the air in the bedroom is often warm and dry. On top of that, the body's own cortisol levels drop at night. That is why your child wakes at eleven or twelve with a cough that sounded normal at bedtime.
Does going out into cold air help?
Yes, that is what usually works best. Cool air shrinks the swelling slightly. Take a blanket, go out onto the balcony or open the window, and sit with your child upright on your lap. Calm is just as important, because crying makes the breathing worse.
When should we call 112?
When your child has difficulty breathing even at rest, when the skin pulls in at the base of the throat and between the ribs with every breath, when the lips turn bluish, when your child becomes drowsy or cannot drink or talk. Do not wait. With croup, better an unnecessary call than one that comes too late.
Does it come back?
Often, yes. A child who has had croup once tends to get it again with the next cold, until they grow out of it at around three to five years when the airway has widened. If your child has had it several times, the healthcare service can prescribe medication to keep at home, and it is worth asking about.