Croup Cough At Night: What To Do And When To Worry

A barking cough, a hoarse voice, and a child who woke up upset: that’s the classic sign of croup, and croup is usually worst at night.

Croup usually gets better on its own, and there’s a lot you can do at home tonight. Keep your child calm and sitting up, offer fluids, and treat a fever if they’re uncomfortable. The thing to watch is their breathing, not the cough. If you hear a harsh, noisy sound every time they breathe in while they’re resting quietly, or they’re working hard to breathe, call 911 or go to the emergency room, even in the middle of the night.

Croup: The Short Answer

• What It Is: swelling of the voice box and windpipe, caused by a virus.
• Watch The Breathing, Not The Bark. Noisy breathing while calm, struggling to breathe, blue lips or drooling means call 911.
• At Home Tonight: keep them calm and upright, offer sips of fluid, call us before giving any medicine, and skip the cough syrup.
• Nights Two And Three Are Often The Worst. Most croup lasts up to 3 nights, sometimes up to 7.
• If You’re Not Sure, call Maryland Pediatric Care at 301-424-2400. After hours, the line can connect you to the doctor on call.

Table Of Contents

1. Croup: The Short Answer
2. What Does A Croup Cough Sound Like?
3. When Does Croup Need 911 Or The ER?
4. How To Help A Croup Cough At Night At Home
5. Why Is Croup Worse At Night?
6. Croup: When To Worry And When To Call
7. What Will The Doctor Do For Croup?
8. Croup Resources For Parents
9. Get Your Child Seen For Croup In Germantown

What Does A Croup Cough Sound Like?

A croup cough is a loud, harsh barking cough. It usually comes with a hoarse voice, and sometimes with stridor, a high-pitched, rasping noise your child makes when they breathe in. Those sounds are what set croup apart from an ordinary cough.

Croup itself is swelling of the voice box and windpipe. Viruses cause it, most often one called parainfluenza, which accounts for about 3 in 4 cases, and it may start out looking like an ordinary cold. Babies and toddlers between 3 months and 5 years old get it most, and it shows up most between October and April.

The bark is loud and scary, but on its own it isn’t one of the emergency signs. Stridor while your child is resting quietly is. Stridor that comes and goes, and is gone once your child is calm, still earns a call to your pediatrician within a day.

Record The Breathing: if you can, take a short video on your phone of your child breathing while they’re calm, with their chest showing. It lets the doctor or nurse hear exactly what you’re hearing.

Is Croup Contagious?

It is. The viruses that cause croup spread easily from person to person when someone who is sick coughs or sneezes, and croup is most common in fall and winter. If you’re unsure when your child can go back to daycare or school, give Maryland Pediatric Care a call and we’ll talk it through with you.

“I will definitely recommend this practice to anyone they took care of my children since birth, know how to talk and console children ,available to be reach anytime even at night i don’t think i can’t take my kids somewhere else …”

When Does Croup Need 911 Or The ER?

Call 911 or go to the nearest emergency room right away if your child:

• Makes a harsh, noisy sound (stridor) with every breath while resting
• Is struggling to breathe or having trouble breathing, or the skin pulls in between the ribs when they breathe in (doctors call these retractions)
• Can’t speak or cry because they can’t get enough breath
• Has bluish or gray lips, fingernails or skin
• Is drooling or has great difficulty swallowing
• Is very sleepy or hard to wake

Don’t wait until morning for any of these. The American Academy of Pediatrics advises calling your child’s doctor, going to the emergency department or calling 911 if you’re worried your child’s croup isn’t getting better, even in the middle of the night.

Epiglottitis, a dangerous infection usually caused by bacteria, can look a lot like croup, which is one more reason those signs never wait.

How To Help A Croup Cough At Night At Home

If none of the emergency signs are there, these steps help most children through the night.

1. Stay Calm, And Help Them Stay Calm. Being upset and crying can make the cough and the work of breathing worse. Hold them, read to them, put on a favorite show.
2. Keep Them Sitting Up. Hold them upright on your lap rather than laying them flat.
3. Offer Fluids in small, frequent sips. Our guide to keeping a sick baby hydrated has ideas by age.
4. Ask Before Giving Fever Medicine. Call us first, so the doctor can tell you what’s safe for your child’s age and weight.
5. Skip The Cough Syrup. Cough syrups don’t help croup and may do harm. The FDA also says children under 2 should not get any cough and cold product with a decongestant or antihistamine in it.
6. Sleep In The Same Room. Being close by means you’ll be there if they start having trouble breathing.

Does Steam Or Cool Night Air Help Croup?

The evidence says probably not. The American Academy of Pediatrics (AAP) says there are no studies proving that a steamy bathroom or cool night air helps croup, and the NHS in the UK advises against steam. Never use very hot water or steam near a child, because it can burn, and never let any home remedy delay care.

Why Is Croup Worse At Night?

Croup is usually at its worst at night. The barking cough and noisy breathing often wake a child from sleep, and crying or being upset makes both worse. That’s why helping your child calm down is one of the most useful things you can do in the middle of the night: a calmer child usually breathes more easily.

The second and third nights are often the worst. If tonight is night one, plan for a couple more rough ones, and keep watching the breathing the same way each night. Each night, the signs that mean call 911 stay the same: stridor while resting, struggling to breathe, or blue or gray lips.

How Long Does Croup Last?

Most croup lasts up to 3 nights, and it can go on for up to 7. The barking cough itself can hang around for up to 2 weeks. If the bark is still there after 14 days, or your child has now had croup 3 or more times, call Maryland Pediatric Care during office hours so we can take a look.

Croup: When To Worry And When To Call

Some croup signs need 911, and some can wait until the office opens.

Adapted from the Seattle Children’s croup guidelines and the AAP.

What If Maryland Pediatric Care Is Closed?

For a true emergency, call 911. For advice, you can use the 24-hour nurse line on the back of your health insurance card. For an urgent question that can’t wait until morning, call Maryland Pediatric Care at 301-424-2400 and follow the directions to be connected to the doctor on call. A fee may apply if it turns out not to be urgent. Our after-hours care page has the details.

Have These Ready When You Call: your child’s age and weight, when the cough started, their temperature, when they last peed or had a wet diaper, and whether they have been treated for croup before.

During office hours, ask for a same-day sick visit. You can book a visit online or call.

“First and Foremost, I absolutely loved how even though my babies had never been to Dr. Malik’s practice, as soon as I called to reset their appointment since they have been under the weather, reception did not hesitate to schedule me on the same day to bring them in due to them feeling ill. From reception, MA to Dr. Malik, I appreciated the attentiveness and peace of mind provided!”

What Will The Doctor Do For Croup?

The doctor will examine your child first, listening to their breathing and checking how hard they’re working to breathe. Then the doctor decides whether your child needs medicine to bring down the swelling in the voice box, and which treatment is right for your child.

Antibiotics don’t help croup, because it’s caused by a virus. If your child also seems to be catching every bug going around, our guide to the 10 most common childhood illnesses covers what to expect from each.

Can Croup Come Back?

It can, and some children get croup more than once. When croup keeps coming back, or hangs on much longer than expected, it can be a sign of a narrowing in the airway that has nothing to do with infection. If your child has had croup 3 or more times, call Maryland Pediatric Care during office hours and we’ll talk through whether to look further.

Croup Resources For Parents

• HealthyChildren.org (American Academy of Pediatrics): Croup In Young Children. The AAP’s own parent guide, including its full list of emergency signs.
• MedlinePlus (U.S. National Library of Medicine): Croup. A plain-language overview of causes, how long croup lasts, and treatment.
• Seattle Children’s: Croup. A step-by-step guide to when to call 911, when to be seen now and when to call the next day.
• NHS: Croup. The UK health service’s guidance, including its advice against steam.
• FDA: Use Caution When Giving Cough And Cold Products To Kids. Which over-the-counter medicines to avoid in young children.
• CDC: About Human Parainfluenza Viruses. A common virus family linked to croup, and how it spreads.

Get Your Child Seen For Croup In Germantown

If your child is struggling to breathe, call 911. For everything else, call Maryland Pediatric Care at 301-424-2400. During office hours we offer same-day sick visits, and after hours the line can connect you to the doctor on call. You’ll find us at 19525 Doctors Drive in Germantown, caring for kids from prenatal visits through the teen years. See all of our pediatric services.

Written by Aniqa Malik, MD, FAAP

Dr. Aniqa Malik is a pediatrician and a Fellow of the American Academy of Pediatrics (FAAP) at Maryland Pediatric Care, 19525 Doctors Drive in Germantown, Maryland.