Croup: the barking cough at 2am, what to do at home, and when to call a GP
Every parent who has heard it remembers the first time: a seal-like barking cough in the middle of the night, a frightened child, and that split second of panic while you work out what is happening. Croup is one of the most common reasons young children need urgent advice, and the honest answer is that most children recover at home within a couple of days. But a small number need steroids or urgent hospital care, and knowing the difference is what lets you act calmly at 2am. At The Online GP by The Wellness, our doctors assess children with croup symptoms by video every week, and most parents tell us the clear plan alone was worth the call.
Key points
Croup is a viral illness that causes swelling around the voice box and windpipe, producing the classic barking cough and a harsh sound when breathing in (stridor).
It mainly affects children between six months and five years, peaking between one and two years old.
Most cases are mild and settle within two to three days with calm, reassuring home care.
A single dose of steroid (usually dexamethasone) shortens the illness and is the evidence-based treatment when symptoms are more than very mild.
Struggling to breathe, drooling, extreme tiredness or a blue tinge around the lips means call 999 immediately.
A same-day phone consultation at The Online GP costs from £59, with clear safety-netting and a prescription arranged where appropriate.
What croup actually is
Croup is inflammation of the upper airway, usually triggered by a common cold virus such as parainfluenza. The swelling sits just below the vocal cords, which is why the cough sounds so distinctive: a harsh bark, often compared to a seal. Children may also have a hoarse voice and a low-grade fever. It typically starts like an ordinary cold, then the cough arrives at night, which is why so many families first meet croup in the small hours.
It is most common between October and March, exactly the season London families are now entering. Children under six are affected most because their airways are small, so a little swelling goes a long way.
The midnight cough: what the sounds mean
The single most useful skill for a parent is learning to tell the sounds apart:
The barking cough sounds alarming but on its own, in a child who is breathing comfortably and playing between coughing fits, usually means mild croup.
Stridor is a harsh, raspy noise when your child breathes in. Stridor only when upset or crying suggests moderate croup. Stridor while resting quietly is a warning sign that needs urgent assessment.
Working hard to breathe, with the skin between the ribs or at the base of the throat pulling in with each breath, means the airway is narrowing and your child needs emergency care.
What to do at home tonight
The evidence for home care is clear, and some of it surprises parents:
Stay calm and keep your child calm. Crying narrows the airway further and makes breathing harder. Cuddles, a quiet story and a settled parent genuinely help.
Sit your child upright on your lap rather than laying them flat.
Offer sips of fluids little and often to keep them hydrated.
Skip the steam. The old advice to sit in a steamy bathroom has been dropped: studies show it makes no difference, and it carries a scalding risk. Cool night air from an open window is harmless and many parents feel it settles the cough, but it is comfort, not treatment.
Give paracetamol or ibuprofen if there is fever or discomfort, following the dose on the bottle for your child's age.
When a pharmacy is enough, and when you need a GP
A mild barking cough in a child who is drinking, playing and breathing comfortably can be watched at home. Your pharmacist can advise on fever medicines.
Book a same-day GP consultation if:
the cough is getting worse rather than better after 48 hours;
your child has stridor when upset or crying;
they are not drinking enough, or wet nappies have dropped off;
they have an underlying condition such as asthma, prematurity or a heart or lung problem;
you simply cannot tell how bad it is. That uncertainty is exactly what a consultation is for.
For croup that needs treatment, the evidence-based answer is a single dose of dexamethasone, a steroid that reduces airway swelling within hours. NICE guidance supports it for children with symptoms beyond the mildest. Our doctors can assess your child by video, watch how they are breathing, and arrange a prescription to your local pharmacy the same day where it is safe and appropriate. If your child needs to be examined in person, we will tell you plainly and direct you to the right place.
When to call 999
Call an ambulance immediately if your child:
is struggling to breathe, with visible pulling in of the chest or throat;
has stridor while resting quietly;
is drooling or cannot swallow their own saliva;
is unusually drowsy, floppy or difficult to wake;
develops a blue or grey tinge to the lips, tongue or skin.
These signs are uncommon, but they are the reason croup deserves respect. Trust your instincts: if your child looks seriously unwell to you, treat it as an emergency.
What it costs
A walk-in urgent care visit in central London can run to £100 to £250 before any prescription, often with a wait in a room full of other unwell children. A phone consultation at The Online GP costs £59 for 15 minutes, a video consultation £150, and an in-person appointment £220. For most children with croup symptoms, a phone or video call is all that is needed, and you will know within minutes whether home care is enough or a steroid prescription is warranted. The NHS remains the right route for many families, and 111 is there overnight; our role is to be there when you want a doctor's full attention, now, without the wait.
Why parents choose The Online GP by The Wellness
When your child is barking like a seal at midnight, you do not want to spend an hour wondering whether to wake a sleeping household for a trip to A and E. Our GMC-registered doctors answer quickly, assess carefully, and give you a plan you can act on: watchful waiting with clear safety nets, a same-day prescription, or an honest instruction to go straight to hospital. We would rather tell you your child is fine and charge you for reassurance than have you spend the night worrying. Most parents tell us that clarity alone was worth the call.
Book a same-day phone consultation from £59, or message us on WhatsApp at +44 7961 280835 and we will find you the next available doctor. You can also call 020 3951 3429.
Frequently asked questions
How long does croup last?
The barking cough typically peaks over two to three nights and settles within a week. The worst night is usually the first or second. If your child is getting worse after three days, or the cough lasts beyond a week, speak to a GP.
Is croup contagious?
The viruses that cause croup spread like ordinary colds, so siblings and nursery friends can catch the virus, though most will just get a common cold rather than croup itself. Keep your child home while they are unwell and feverish, as you would with any virus.
Can a GP prescribe anything for croup?
Yes. A single dose of dexamethasone, a steroid, is the standard evidence-based treatment for croup that is more than very mild. It works within hours and often prevents a hospital visit. Severe cases may need nebulised adrenaline in hospital, which is why severe breathing difficulty means 999, not a phone call.
Should my child stay off nursery or school?
Keep them home while they have a fever or feel unwell, usually two to three days. Once they are back to themselves and fever-free for 24 hours, they can return, even if a mild cough lingers.
Is it croup or something more serious?
Croup has a distinctive barking cough and usually follows a cold. A child who is drooling, leaning forward, refusing to swallow and looking very unwell may have something rarer such as epiglottitis, which is an emergency. If your instinct says this is not an ordinary barking cough, call 999 or seek urgent assessment.
How much does a consultation cost at The Online GP?
Phone consultations are £59 for 15 minutes, video consultations £150, and in-person appointments £220 at our clinic at Unit 4, 10 Portman Square, London W1H 6AZ. There are no hidden fees, and any prescription is sent electronically to a pharmacy near you.
References
NICE Clinical Knowledge Summary: Croup, last revised 2024.
NHS: Croup, reviewed 2024.
Royal College of Emergency Medicine: management of acute upper airway obstruction in children, 2023.
Bjornson C et al, Cochrane Database of Systematic Reviews: glucocorticoids for croup in children, 2023.
Written by The Wellness Team and medically reviewed by The Wellness Clinical Team. This article is general information and is not a substitute for a personal consultation. If your child is struggling to breathe, call 999.