From the Guidelines
Croup is a viral respiratory infection characterized by a barking cough, hoarseness, and stridor, with six key signs including a distinctive barking cough, stridor, hoarseness, respiratory distress, fever, and symptoms worsening at night. The treatment of croup depends on the severity of the condition, but it often includes a single dose of oral dexamethasone to reduce airway inflammation, as supported by recent studies 1.
Key Signs and Symptoms
- A distinctive barking or "seal-like" cough
- Stridor (especially when agitated or crying)
- Hoarseness
- Respiratory distress with retractions
- Fever
- Symptoms that typically worsen at night
Treatment
- A single dose of oral dexamethasone (0.6 mg/kg, maximum 10 mg) to reduce airway inflammation
- For moderate to severe cases, nebulized epinephrine (racemic epinephrine 2.25% solution, 0.5 mL in 2.5 mL normal saline) may be used in medical settings, although its effect is short-lived (1-2 hours) 1
- Home management includes keeping the child calm, ensuring adequate hydration, using cool mist humidifiers, and sitting in a steamy bathroom
When to Seek Medical Attention
- Significant breathing difficulty
- Appears blue
- Is excessively drowsy
- Cannot drink fluids Most cases of croup resolve within 3-7 days, and the condition occurs because viruses cause inflammation and swelling of the larynx and trachea, narrowing the airway, particularly affecting children aged 6 months to 3 years whose airways are naturally smaller. The use of a clinical guideline and orderset can help reduce hospital admissions for croup, as shown in a recent study 1.
From the Research
Croup Signs and Symptoms
- Croup is characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction 2
- The disease leads to signs of upper airway obstruction and must be differentiated from acute epiglottitis, bacterial tracheitis, or an inhaled foreign body 2
- Croup 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 Assessment
- The assessment of airway, breathing, and circulation, focusing on airway, is paramount in treating croup 3
- Laboratory studies are seldom needed for diagnosis of croup, and viral cultures and rapid antigen testing have minimal impact on management 4
- Radiography and laryngoscopy should be reserved for patients in whom alternative diagnoses are suspected 4
Treatment and Management
- 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
- In patients with moderate to severe croup, the addition of nebulized epinephrine improves symptoms and reduces length of hospitalization 4
- Corticosteroids, such as dexamethasone, and nebulized epinephrine are effective treatments for croup, with dexamethasone being more effective by clinical evaluation at 6 and 12 hours post-admission 5
- The introduction of steroids in the treatment of croup has seen a significant reduction in hospital admissions and improved outcomes for children 3