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Croup is defined as the inflammation and swelling of the larynx (voice box) and windpipe. It is caused by a cold or viral infection. Croup mainly occurs in children between the ages of six months and two years.

Some children are more prone to developing croup than others. And, repeatedly at that. Although there is no sure evidence, Johannesburg-based paediatrician Dr Johnny Lotter says: “There seems to be a family inheritance pattern for children at risk of getting croup. Perhaps it’s that they have a smaller airway, or a tendency to swell quicker when confronted with viral infection.”

Croup is highly contagious. It is contracted in the same way as the common cold. The majority of infections occur in autumn and winter (March and September).


Typically, croup starts with a cold, often presenting as only that for several days. It is then followed by a hoarse voice and a barking cough in mild instances or difficult and noisy breathing in severe cases. The symptoms will be worse at night and normally last three to six nights. The first two nights are usually the most severe. Other symptoms include fever, lethargy, irritability and poor appetite.


Most cases of croup are not severe and can be safely managed at home. Get your child to inhale warm, misty steam and take in plenty of fluids. You can also give them acetaminophen (or paracetamol) for the fever and to alleviate discomfort. Sometimes, a dose of oxygen via a nebuliser (medicine should only be added to the nebuliser if ordered by a doctor) may be needed. If needed, your doctor will prescribe cortisone and, in severe cases, an adrenaline solution to breathe in via a nebuliser, to treat the swelling in the voice box. Doctors advise against giving your child cough mixture as it is commonly believed to not really work and has potential side effects. Besides, with acute respiratory infections in children, coughing is good so it should not be suppressed.”

When winter ailments like coughs and colds strike, try these flu-boosting foods to fight them off.

When to seek help

Lotter says: “It is important to know that your child’s windpipe is as big as his small finger, so only a small amount of swelling leads to a large decrease in airway diameter.” If your child is not responding to home treatment and you notice any one of the following symptoms, take them straight to a doctor:

  • they are very agitated
  • have difficulty breathing
  • they are struggling to breathe deeply
  • there is a tugging between the ribs when breathing in
  • you notice a change in the colour of their lips or skin.

However, Lotter encourages you to seek medical attention from the onset. “If a child wakes up barking and battling to breathe, don’t wait until the morning to address the problem.”

Lucille Kem