Croup in Kids: Barking Cough at Night & When to Go to the ER

Quick answer: Croup is a common viral infection that swells the upper airway, causing a harsh “barking” cough, a hoarse voice, and sometimes a high-pitched squeaky sound when breathing in (called stridor). It usually affects children between about 6 months and 3 years old and is often worst at night. Most cases are mild and get better at home in 3 to 5 days. Get emergency care right away if your child is struggling to breathe, has stridor while calm and resting, is drooling or can’t swallow, or looks blue or gray.

Call 911 or go to the ER now if your child:

Is working hard to breathe, or you can see the skin pulling in between the ribs, below the ribcage, or at the base of the neck
Makes a squeaky or whistling sound (stridor) when breathing in while calm and resting, not just when crying or upset
Is drooling, having trouble swallowing, or refusing to swallow their own saliva
Has blue or gray lips, face, or nails
Can’t speak or cry because of trouble breathing
Is very sleepy, hard to wake, or unusually agitated and restless

Also go to the ER if a cough or breathing trouble started suddenly with no cold symptoms, especially in a toddler who was playing with small objects or food. This can be a sign of something stuck in the airway.

What is croup?

Croup is swelling of the voice box (larynx) and windpipe (trachea), usually caused by a virus. Parainfluenza viruses are the most common cause, but flu, RSV, COVID-19, and other cold viruses can cause it too. Children’s airways are small, so even a little swelling narrows them enough to change the sound of their cough and breathing. Croup is most common in fall and winter.

What croup sounds like

A barking cough that sounds like a seal or a small dog
A hoarse voice or cry
Stridor: a high-pitched, squeaky sound when your child breathes in, often louder when they’re upset
Cold symptoms like a runny nose and a low-grade fever, usually starting a day or two before the cough

Why croup is worse at night

Many children seem fine during the day and then wake up at night with a barking cough and noisy breathing. Symptoms are usually worst on the first two or three nights and then gradually improve. Most children recover within 3 to 5 days, though a mild cough can linger a bit longer.

How to comfort your child at home

Stay calm and keep your child calm. Crying and fear make the airway swelling and breathing sounds worse. Hold your child, read, sing, or offer a favorite show. This is one of the most helpful things you can do.
Try cool air. Many parents find that a few minutes of cool night air (bundled up by an open window or outside) or a cool-mist humidifier helps their child feel more comfortable. Research hasn’t shown that mist or humidity treats croup, so don’t rely on it if your child has any warning signs above. Never use hot steam or boiling water, which can cause burns.
Keep your child upright. Sitting up or being held upright can make breathing more comfortable.
Offer fluids often. Breast milk, formula, water, or ice pops help keep your child hydrated.
Treat fever and discomfort. Ask your pediatrician which fever reducer and dose is right for your child’s age and weight. Never give aspirin to children.
Skip cough and cold medicines. They don’t help croup and aren’t recommended for young children unless your doctor advises them.
Sleep nearby. Consider sleeping in the same room during the worst nights so you can hear changes in your child’s breathing.

When to call your pediatrician

Stridor that goes away with calming but keeps coming back
Your child is younger than 6 months old and has croup symptoms
Fever that lasts more than 3 days or keeps rising
Symptoms that aren’t improving after 3 to 5 days, or are getting worse
Signs of dehydration, such as fewer wet diapers, a dry mouth, or no tears when crying
Your child has had croup many times, or you’re simply worried

How doctors treat croup

Your pediatrician can usually diagnose croup by listening to the cough and breathing. For many children, a single dose of a steroid medicine (often dexamethasone) is prescribed to reduce airway swelling. It usually starts working within a few hours. For more severe breathing trouble, children may receive a breathing treatment with epinephrine in the ER and be watched for several hours afterward. Antibiotics don’t help croup because it’s caused by a virus.

Can croup be prevented?

Croup spreads like a cold, through coughs, sneezes, and unwashed hands. Handwashing, covering coughs, and keeping sick children home help reduce spread. Staying up to date on vaccines, including the yearly flu vaccine for children 6 months and older, protects against some viruses that can cause croup and against more serious airway infections that can look similar.

Frequently Asked Questions

What does a croup cough sound like?

A croup cough sounds harsh and barking, like a seal or a small dog. Children often also have a hoarse voice and may make a squeaky, high-pitched sound when breathing in.

Is croup contagious?

The viruses that cause croup are contagious and spread through coughs, sneezes, and hands. They’re most contagious during the first few days of illness and while your child has a fever.

How long does croup last?

Most cases of croup improve within 3 to 5 days. Symptoms are usually worst on the first two or three nights.

Does cold air or steam help croup?

Many parents find that cool night air or a cool-mist humidifier helps their child feel more comfortable, but research hasn’t shown that mist treats croup. Keeping your child calm is one of the most helpful things you can do. Never use hot steam, which can cause burns.

When is croup an emergency?

Get emergency care if your child is struggling to breathe, has stridor while calm and resting, is drooling or can’t swallow, has blue or gray lips or face, can’t speak or cry, or is very sleepy or hard to wake.

Related guides

Sources

This article is for general information and is not a substitute for advice from your child’s doctor. If your child is having trouble breathing, call 911 or go to the nearest emergency room.

Croup in Kids: Barking Cough at Night, What to Do, and When to Go to the ER