Thank you to Cleo for submitting the following question:

Hi Sarah. I had a question in a class yesterday about croup. I looked on-line and there seems to be some conflicting information about the best way to manage croup including whether stream is of any benefit. Are you able to provide an overview of croup, the best way to manage it and any significant signs/symptoms which would indicate the need for emergency help. Thanks Cleo.

Reply by Sarah Huntstead – Paediatric Emergency Department Nurse

Hi Cleo, thank you for your question.

Croup is caused by a viral infection. There are other illnesses that can present with similar symptoms to croup that are caused by bacterial infections, and in the past diphtheria was a common fatal cause. Now with immunisations, bacterial infection rate has dropped significantly. Viral croup is by far the most common.

The viral infection causes swelling of the upper airway (larynx and trachea), as opposed to asthma which affects the lower airways.

Symptoms of croup include
• Common cold symptoms
• Barking cough (like a dog or seal)
• Hoarse voice
• Stridor (inspiratory sound)
• Sometimes the child may have a fever

Croup often gets worse at night. Croup can range from mild to severe, possibly needing hospitalisation. If croup is moderate – severe, steroids or inhaled adrenaline may be needed to reduce the swelling in the airway. It doesn’t “cure” the illness, it just reduces the swelling therefore helping the symptoms.

It is of utmost importance to keep the child calm – the more upset they get, it becomes much more difficult to breathe. Keeping them calm will assist in their breathing.

Steam has been shown to be of no assistance at all. Think about it this way – if you sprained your ankle and it immediately started to swell, would you put ice on it or a hot water bottle? Same with croup – steam will not reduce the swelling. I have had a few parents tell me that steam worked, however their child also calmed down at the same time. This is the likely reason the breathing improved, rather than the steam.

You would need to seek urgent medical help if the child 
• Has blue lips (000)
• Is sucking in around the tummy or ribs when breathing (laboured breathing) (000)
• Is very distressed and can’t be calmed
• Has stridor at rest (calm)
• You are concerned

The Royal Children’s Hospital have a great resource sheet –

Let me know if you would like more info!