Croup is an acute infective respiratory disease affecting young children. It typically affects children aged 6 months to 2 years, however they can be older. It is an upper respiratory tract infection causing oedema in the larynx. The classic cause of croup that you need to spot in your exams, is parainfluenza virus. It usually improves in less than 48 hours and responds well to treatment is steroids, particularly dexamethasone.

 

Causes

The common causes for croup are:

  • Parainfluenza
  • Influenza
  • Adenovirus
  • Respiratory Syncytial Virus (RSV)

Croup used to be caused by diphtheria. Croup caused by diphtheria leads to epiglottitis and has a high mortality. Vaccination mean that this is very rare in developed countries.

 

Presentation

  • Increased work of breathing
  • Barking” cough, occurring in clusters of coughing episodes
  • Hoarse voice
  • Stridor
  • Low grade fever

 

Management

Most cases can be managed at home with simple supportive treatment (fluids and rest). During attacks it can help to sit the child up and comfort them. Measures should be taken to avoid spreading infection, for example hand washing and staying off school.

Oral dexamethasone is very effective. This is usually a single dose of 150 mcg/kg, which can be repeated if required after 12 hours. Prednisolone is sometimes used as an alternative where dexamethasone in not available (e.g. by GPs).

Stepwise options in severe croup to get control of symptoms:

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

 

Last updated August 2019
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