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This article is for general information only and does not replace medical advice. If in doubt, contact your paediatrician or midwife.

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Croup (Pseudocroup) in Babies

Croup is a barking cough that terrifies parents at night. The typical attack comes suddenly — usually between 10 PM and 2 AM — with a barking cough, hoarse voice, and whistling on inhalation. As frightening as it sounds: most cases are harmless and can be well managed at home.

Possible Causes

  • 1Parainfluenza virus (most common cause — about 75% of all cases)
  • 2Other viruses: RSV, influenza, adenoviruses
  • 3Swelling of the mucous membrane below the vocal cords (subglottic)
  • 4Cold, dry air in autumn/winter worsens symptoms
  • 5Allergic component in recurrent croup (spasmodic croup)

What You Can Do

  • Stay calm — anxiety worsens breathing difficulty (hold your child, soothe them)
  • Cool, moist air: open a window, step onto the balcony, or run cold water in the bathroom
  • Let the child sit upright — makes breathing easier
  • Corticosteroid suppository (prednisolone) as emergency medication — should be at home after the 2nd episode
  • Inhalation with saline solution (nebuliser) for mild cases

When to See a Doctor

  • Severe breathing difficulty: chest retractions (between ribs, at the throat)
  • Bluish discolouration of lips or fingernails (cyanosis) → EMERGENCY 911/112
  • Child cannot speak, swallow, or drink
  • Drooling — may indicate epiglottitis → EMERGENCY
  • High fever above 39°C with breathing difficulty (distinguishing from epiglottitis is critical)
  • Corticosteroid suppository doesn't take effect within 30 minutes

Age-Specific Notes

Most common between 6 months and 3 years — the larynx is still narrow and swells quickly. Boys are affected more often than girls. Children over 6 rarely get croup as the larynx has grown. Some children are prone to recurrent croup (spasmodic croup) — allergic predisposition often plays a role.

Frequently Asked Questions

Why does croup always come at night?
At night, the body's cortisol level drops to a minimum. Cortisol is a natural anti-inflammatory. Without this brake, the already irritated mucous membrane swells more. That's why croup attacks almost always occur between 10 PM and 2 AM.
Should I take my child into cold air during croup?
YES! Cool, moist night air is one of the most effective immediate measures. Wrap your child warmly and go onto the balcony or outside for 10-15 minutes. The cold air reduces the swelling.
Do I need emergency corticosteroid suppositories?
After the first croup attack, discuss with your paediatrician whether a corticosteroid suppository should be kept at home as emergency medication. It works within 30 minutes and can prevent a severe episode.
Is croup dangerous?
In the vast majority of cases, NO. The cough sounds worse than it is. Rarely (< 5%) is hospitalisation needed. BUT: if your child develops blue lips, can't drink, or shows no improvement despite corticosteroids — call an ambulance immediately.

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This article is for general information only. It does not replace individual medical advice. If you have concerns, contact your paediatrician, midwife, or call emergency services.