Croup
Acute laryngo-tracheo-bronchitis
Commonly by Para-nfluenza 1 virus in young children 6m to 6y age
Consider differentials:
– Epiglottitis
– Bacterial Tracheitis
– Foreign body
– Congenital stridor
Presentation/ History:
Illness starts with runny nose,
cough, sore throat
Fever generally low grade
Within 1-2 days,
– Hoarseness
– Barking cough (like a seal)
– Inspiratory stridor, worse at night
Assessment/ Examination:
– Keep the child comfortable
– Avoid inspecting throat / canullating
– Record Temp, HR, RR, SaO2
– Monitor ‘alertness’ / AVPU
Red Flags:
– Stridor biphasic & at rest
– Hypoxia, resp distress
– Reduced consciousness
– ‘Toxic’ appearing- ? suspect Epiglottitis
– Downs synd/ other
– Atypical croup- ?suspect laryngeal web/
subglottilc stenosis
Management:
Assess severity & risk factors
Avoid distressing the child
Discharge when:
– No stridor at rest
– Clinically improving
– SaO2>92% in air
– Parents educated about croup
& warning symptoms explained
Mild Croup:
– Oral Dexamethasone
150mcg/kg single dose, or
– Budesonide neb 2mg
– Home with advice
Mod/ Severe Croup:
– Admit, give O2 if SaO2 <92
– Oral Dexamethasone/
Neb Budesonide
– Review every 1 – 2 hours
– If worsening, give
Adrenaline nebulised
0.4ml/kg of 1:1000
(max 5ml of 1:1000),
can repeat in 30 – 60 minutes
– Call Anaesthetist & Senior support
Bjornson CL, Johnson DW. Croup. Lancet 2008;371(9609):329–39.
Joshi V, et al. Fifteen-minute consultation: structured approach to management of a child with recurrent croup. Arch Dis Child Educ Pract Ed 2014;99(3):90–3.
Klassen TP, Craig WR, Moher D, et al. Nebulised budesonide and oral dexamethasone for the treatment of croup: a randomised controlled trial. JAMA 1998;279:1629-1632.