Coughing causes vomiting 3 or more times. You think your child needs to be seen, but the problem is not urgent. Fever returns after being gone more than 24 hours. Age less than 1 year old with a croupy cough. Stridor (harsh sound with breathing in) occurred but not present now. You think your child needs to be seen, and the problem is urgent. Caution: do NOT give your baby any fever medicine before being seen. High-risk child (such as cystic fibrosis or other chronic lung disease). Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids. Lips or face have turned bluish during coughing. Stridor (harsh sound with breathing in) is heard now. You think your child has a life-threatening emergency. 
Drooling, spitting or having great trouble swallowing.Croup started suddenly after bee sting, taking a new medicine or allergic food.
Lips or face are bluish when not coughing. Severe trouble breathing (struggling for each breath, constant severe stridor). This can be life-threatening (anaphylaxis). Croup symptoms can also be caused by a food allergy. Suspect when there is a sudden onset of coughing and choking. Examples are powdered sugar, flour dust or peanut dust. Breathing in any fine substance can trigger 10 minutes of severe coughing. A runny nose, itchy eyes and sneezing are also often present. A croupy cough can occur with exposure to pollens or allergens in a barn. A fever is often present with the barky cough. Many respiratory viruses can infect the vocal cord area and cause narrowing. 
Viruses are the most common cause of croup symptoms.
For any stridor, see First Aid for treatment. Most children with stridor need treatment with a steroid (such as Decadron). All stridor needs to be treated with warm mist. So does stridor at rest (when not crying or coughing). Loud or constant stridor means severe croup. Stridor is a harsh, raspy tight sound best heard with breathing in. Some children with severe croup get a harsh, tight sound while breathing in. The voice or cry is hoarse (called laryngitis). 
The croupy cough is tight, low-pitched, and barky (like a barking seal).Croup is a viral infection of the voicebox (larynx).Barky cough and hoarse voice caused by a virus.
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