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Croup: the facts

Croup is caused by a virus that inflames the windpipe.  It is most common in children under the age of five.  The symptoms of croup include fever and barky cough.  Croup is almost always worse in the middle of the night.

Although the symptoms of croup can be frightening, it is almost always a mild illness.  While about 6% of children under age five will contract croup, only 0.4% of children will be hospitalized.  Croup is a self-resolving illness.  The nighttime cough and fever can last for 1-3 days, and a mild daytime cough may last for up to 10 days.

Croup: the plan

Croup can often be treated at home without medications.  If the croupy cough is persistent, croup can be treated with a one day course of Orapred (prednisolone), an oral steroid.  Orapred decreases the swelling in the windpipe and quiets the barky cough of croup.  If your child should come down with croup, please read our “Nighttime Croup Attack Plan” below.  As always, please contact us with any questions!


Nighttime Croup Attack Plan

Please follow this plan in the event that your child awakes in the night with a fever and a barky cough.

  1. If your child is under 6 months old, call the office.  If your child is drooling unusually, is difficult to wake up, or if his/her lips, hands or feet are blue, call 911 and then follow steps 2 and 3 below.
  2. Take your child into a warm steamy bathroom for 10 minutes.
  3. If the cough does not clear, take your child into the cold night air or open a freezer door to breathe the cold air for 10 minutes.
  4. If the cough clears consider running a humidifier in the room or opening the bedroom window.  If your child sleeps in a bed, you may want to prop him/her up on extra pillows.
  5. If your child still has the barky cough or stridor (a wheezy sound made when they breathe in), give your child a dose of Orapred according to the dosing table.  Continue to use the steamy bathroom or cold air therapy.  The Orapred takes about two hours to work.
  6. Please call or e-mail the office in the morning if you have given your child Orapred so that we may document this in the medical record.
    1. For Westwood Patients the address is wnurse@wmpeds.com.
    2. For Mansfield Patients the address is mnurse@wmpeds.com.
    3. Please note that, while these email addresses are checked frequently, they should not be used for urgent questions.


Orapred (Prednisolone) Dosing Table for Croup


Child’s weight (pounds) Dose (teaspoons)

15 lbs

1/2 teaspoon twice a day for one day

20 lbs

1/2 teaspoon twice a day for one day

25 lbs

3/4 teaspoon twice a day for one day

30 lbs

1 teaspoon twice a day for one day

35 lbs

1 teaspoon twice a day for one day

40 lbs

1 1/4 teaspoons twice a day for one day

45 lbs

1 1/4 teaspoons twice a day for one day

50 lbs

1 1/2 teaspoons twice a day for one day

55 lbs

1 1/2 teaspoons twice a day for one day

60 lbs

1 3/4 teaspoons twice a day for one day

Please call or email in the morning so we know you have started your child on Orapred (prednisolone).