From the Guidelines
Croup is characterized by a distinctive barking cough, hoarseness, and stridor, which can be mistaken for other conditions, such as infantile hemangioma of the airway, which also presents with biphasic stridor and barky cough, as noted in a study published in Pediatrics in 2015 1. The symptoms of croup can be detailed as follows:
- A barking cough that sounds like a seal
- Hoarseness
- Stridor, a high-pitched whistling sound during breathing, which is most noticeable when the child inhales
- Difficulty breathing, with visible retractions of the chest and neck muscles during breathing
- Symptoms typically worsen at night and when the child is upset or crying It is essential to differentiate croup from other conditions, such as infantile hemangioma of the airway, which can cause similar symptoms, including biphasic stridor and barky cough, as reported in the study 1. The pathophysiology of croup involves viral infection causing inflammation and swelling of the larynx and trachea, narrowing the airway, which can lead to significant breathing problems in children due to their smaller airways. In terms of management, most cases of croup are mild and can be managed at home with humidified air and keeping the child calm, while moderate to severe cases may require a single dose of oral dexamethasone to reduce inflammation, as part of the standard treatment approach.
From the Research
Symptoms of Croup
- Croup is characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction 2
- Symptoms usually start like an upper respiratory tract infection, with low-grade fever and coryza followed by a barking cough and various degrees of respiratory distress 3
- Croup is a manifestation of upper airway obstruction resulting from swelling of the larynx, trachea, and bronchi, leading to inspiratory stridor and a barking cough 4
- Many patients experience low-grade fevers, but fever is not necessary for diagnosis 4
Common Symptoms
- Barking cough
- Inspiratory stridor
- Hoarseness
- Respiratory distress
- Low-grade fever
- Coryza
Severity of Croup
- Mild croup is characterized by the presence of stridor without intercostal retractions 5
- Moderate-to-severe croup is accompanied by increased work of breathing 5
- Severe upper airway obstruction can, rarely, lead to respiratory failure and arrest 2
Diagnosis and Treatment
- Laboratory studies are seldom needed for diagnosis of croup 4
- Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended 4
- A single dose of oral, intramuscular, or intravenous dexamethasone improves symptoms and reduces return visits and length of hospitalization in children with croup of any severity 4
- Nebulized epinephrine is an accepted treatment in patients with moderate to severe croup 3, 5