Is it croup or is it something else?

It's a bark-like cough that many children acquire. We take a look at several causes of the stubborn croup.

16 April 2015
by Jennifer Campbell

Croup is a common childhood condition usually caused by a virus, but did you know that there are a number of other conditions that sound like the croup-like bark?

Acid reflux

According to paediatrician Dr Iqbal Karbanee, the most common condition that can mimic the symptoms of croup is acid reflux, which is caused by the regurgitation of milk from the stomach back up the food pipe and into the mouth. The fluid is then vomited out or swallowed back down. Sometimes, explains Dr Karbanee, some of the fluid is not swallowed and small amounts enter the windpipe.

The fluid that comes up from the stomach is not only milk – it also contains stomach acid that is potentially very irritating for the lining of the airway. If even a small amount of the acid gets into the upper part of the airway it can cause a cough.

Dr Karbanee says that most babies will have reflux at some point, although very few will actually have complications. He explains that treatment is two fold: the first is to reduce the actual amount of fluid coming up from the stomach. This involves changing baby’s position so less fluid is able to move up and out of the stomach. This can be done by elevating your baby’s head and shoulders with a wedge pillow during sleep times.

Thickening your baby’s food using special formula feeds can also help reduce the amount of reflux. “All these measures reduce the amount of fluid that comes out of the stomach and up the food pipe. They do not reduce the amount of acid in the actual fluid,” notes Dr Karbanee. If the child coughs after reflux occurs, she may require treatment to reduce the amount of acid. “This should only be done after consultation with your paediatrician,” urges Dr Karbanee.


“A barking cough may sometimes be due to allergies that cause irritation of the airway,” says Dr Karbanee. The most common example is asthma, especially if there is a family history of the condition. Asthma can also occur when your baby suffers from other atopic conditions such as eczema or allergic conjunctivitis.

Nerve injury

In rare cases, says Dr Karbanee, a barking cough can be caused by a nerve injury that may have occurred early in a baby’s life, or as a result of a lack of supporting cartilage in the airway.

“This condition is called laryngomalacia and, although quite rare, should be considered if the infant has noisy breathing and a cough that does not resolve,” says Dr Karbanee.