Croup is an upper respiratory tract infection that causes oedema and inflammation of the larynx and airways.

It typically affects young children aged 6 months to 3 years.

It usually resolves within two days and responds well to treatment with dexamethasone.

 

Causes

Parainfluenza virus is the leading cause of croup.

Other causes include:

  • Influenza
  • Respiratory syncytial virus (RSV)
  • Rhinovirus

 

Presentation

The typical presenting feature is a rapid-onset “seal-like” barking cough.

Other signs and symptoms include:

  • Increased work of breathing
  • Hoarse voice
  • Stridor (high-pitched inspiratory noise)
  • Low-grade fever

 

A few days of coryzal symptoms (e.g., runny nose, dry cough and sore throat) may precede the onset of croup.

TOM TIP: Approach the child calmly and do not scare them, as this can worsen the respiratory distress.

 

Differential Diagnosis

In a child with a rapid-onset of stridor and respiratory distress, the differentials include:

  • Epiglottitis
  • Laryngeal foreign body
  • Angioedema (e.g., caused by anaphylaxis or hereditary angioedema)

 

Management

Dexamethasone (0.15mg/kg) is recommended, even for mild croup. A single dose is usually adequate, but the dose can be repeated after 12 hours if needed. A significant improvement is usually seen within an hour of the dose.

Other management options, if required, in moderate-severe illness include:

  • Oxygen
  • Nebulised budesonide
  • Nebulised adrenalin
  • Intubation and ventilation

 

Last updated February 2025

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