Croup is a common childhood viral illness. Clinically, it is manifested by the sudden onset of a barky cough, hoarseness, and inspiratory stridor which may lead to obstruction and, rarely, to respiratory failure. It typically affects young children between 6 months and 3 years of age and is seen predominantly in boys. It is the most prevalent cause of hoarseness, cough, and acute onset of stridor in the febrile child. While croup can be seen year-round, there is a clear seasonal pattern in North America, with affected children presenting most commonly between the months of November and February. This has been attributed to the biennial peak in human parainfluenza virus epidemics in November. Children may acutely become symptomatic at night and improve during daytime hours. This is often frightening for caretakers, as the distress can be quite dramatic. Although croup is typically a self-limited viral illness that normally resolves over 2 to 5 days, it can require admission to the hospital and, rarely, to the intensive care unit (ICU). The majority of children recover with no complications; however, in very rare instances, it can be life-threatening. The routine use of corticosteroid therapy in the last 30 years has revolutionized the treatment of croup, resulting in a dramatic decrease in the number of admissions to the ICU and the need for invasive therapy such as intubation and mechanical ventilation.1,2
This issue of Pediatric Emergency Medicine Practice focuses on the evaluation and treatment of children with croup by offering a thorough review of the recent advances in treatment. It will provide updated information to the emergency clinician and guidelines on management for primary care providers, who often see these patients early in their illness. Adequate first-line care and follow-up instructions may prevent unnecessary or delayed visits to emergency departments (EDs), alleviate burden on the healthcare system, and minimize stressful situations for caretakers.