From the Guidelines
The treatment for croup in children primarily involves supportive care and medications to reduce airway inflammation, with dexamethasone being the cornerstone of treatment, typically given as a single oral dose of 0.6 mg/kg (maximum 16 mg) 1.
Diagnosis and Treatment
The diagnosis of croup is primarily based on characteristic physical examination findings, including:
- A barking cough
- Inspiratory stridor
- Hoarseness
- Respiratory distress The "steeple sign" on anteroposterior neck X-ray can support the diagnosis but is not routinely needed. Pulse oximetry may show normal oxygen saturation in mild cases but hypoxemia in severe cases.
Treatment Approach
For mild croup, humidified air or sitting with the child in a steamy bathroom may help ease symptoms. In moderate to severe cases, nebulized epinephrine (racemic epinephrine 2.25% solution 0.05 mL/kg or L-epinephrine 1:1000 solution 0.5 mL/kg) may be used for temporary relief of symptoms, but children require observation for at least 2-3 hours after administration due to potential symptom rebound.
Severity Assessment
The severity of croup can be assessed using clinical scoring systems that evaluate the degree of stridor, retractions, air entry, cyanosis, and level of consciousness.
Recent Guidelines
A recent study published in Pediatrics in 2022 1 demonstrated a significant reduction in hospital admissions for croup using a clinical guideline and orderset, highlighting the importance of evidence-based management in reducing morbidity and improving outcomes.
Quality of Life
Effective management of croup is crucial in improving the quality of life for children, as chronic respiratory conditions can have long-term effects on health and well-being 1.
From the Research
Treatment for Croup in Children
- The treatment for croup in children includes corticosteroids, such as dexamethasone, which can be administered orally, intramuscularly, or intravenously 2, 3, 4, 5, 6.
- Nebulized budesonide and oral prednisolone are also effective treatments for croup 2.
- Heliox and humidification may be used in the treatment of croup, although the evidence for their effectiveness is limited 2, 6.
- Nebulized adrenaline (racemate and L-adrenaline [ephinephrine]) can be used to treat moderate to severe croup 2, 3, 4, 6.
- Antihistamines, decongestants, and antibiotics have no proven effect on uncomplicated viral croup 3.
Physical Examination Findings and Diagnostic Tests
- Croup is characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction 2, 4.
- Physical examination findings may include signs of upper airway obstruction, such as stridor and respiratory distress 2, 4.
- Laboratory studies, such as viral cultures and rapid antigen testing, are seldom needed for diagnosis of croup and have minimal impact on management 4.
- Radiography and laryngoscopy should be reserved for patients in whom alternative diagnoses are suspected 4.