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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