A 10-month-old boy, previously fit and well, presented to his A&E at 4 o’clock in the morning with severe respiratory distress. He had a barking cough and inspiratory stridor and was diagnosed with croup. On admission he was treated with two back-to-back adrenaline nebulisations and oral dexamethasone. His work of breathing improved and he was admitted to the paediatric ward for observation. A few hours later, his work of breathing became laboured with increasing stridor, tracheal tug and significant subcostal recession. His respiratory rate was 40 breaths per minute and his heart rate was 170 bpm. He was given a budesonide and adrenaline nebuliser and again his work of breathing and stridor settled.