From the Guidelines
Croup is characterized by a distinctive barking cough, hoarseness, and stridor, typically worsening at night, resulting from inflammation and narrowing of the upper airway, particularly the larynx and trachea, usually caused by viral infections. These symptoms can be accompanied by fever, runny nose, and difficulty breathing. The severity of croup can range from mild to severe, with severe cases showing signs of respiratory distress including rapid breathing, retractions, cyanosis, and agitation. Symptoms often begin with cold-like manifestations before progressing to the characteristic barky cough. Croup primarily affects children between 6 months and 3 years of age, with symptoms typically lasting 3-7 days. The condition is diagnosed clinically based on these characteristic symptoms, though X-rays may show the classic "steeple sign" indicating airway narrowing.
Key Symptoms and Signs
- Barking cough
- Hoarseness
- Stridor
- Fever
- Runny nose
- Difficulty breathing
- Rapid breathing
- Retractions
- Cyanosis
- Agitation Most cases can be managed at home with humidified air and oral steroids like dexamethasone (0.6 mg/kg as a single dose), while severe cases require emergency care with nebulized epinephrine and hospitalization, as supported by recent studies on reducing hospital admissions for croup 1. It's essential to differentiate croup from other causes of respiratory distress, such as foreign-body airway obstruction, which can present with sudden onset of respiratory distress without fever or other respiratory symptoms 1.
From the Research
Croupe Signs and Symptoms
- Croupe is characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction 2
- Common symptoms include:
- Low-grade fever
- Barking cough
- Inspiratory stridor
- Hoarseness
- Respiratory distress
- Symptoms usually resolve within 48 hours, but severe upper airway obstruction can lead to respiratory failure and arrest 2
- Croupe affects about 3% of children per year, usually between the ages of 6 months and 3 years, and 75% of infections are caused by parainfluenza virus 2
Diagnosis and Differential Diagnosis
- Diagnosis is made on clinical grounds with no specific confirmatory test 3, 4
- Differential diagnosis of croupe includes:
- Epiglottitis
- Retropharyngeal abscess
- Bacterial tracheitis
- Foreign body airway obstruction
- Laboratory studies are seldom needed for diagnosis of croupe, and viral cultures and rapid antigen testing have minimal impact on management 4
Treatment Options
- Treatment options for croupe include:
- Humidified air
- Racemic epinephrine
- Adrenal corticosteroids (such as dexamethasone)
- Nebulized budesonide
- Heliox
- A single dose of oral, intramuscular, or intravenous dexamethasone improves symptoms and reduces return visits and length of hospitalization in children with croupe of any severity 4
- Nebulized epinephrine provides effective additional therapy for more severe cases 3, 5