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<< An Evidence-Based Approach To The Evaluation And Treatment Of Croup In Children

Key Points

  • Croup is a common viral childhood illness occurring most often in the late autumn and winter in children between the age of 6 months and 3 years.
  • Croup symptoms usually worsen during the night, making it a frequent chief complaint in the ED.
  • Most cases presenting to EDs are assessed as mild, and mortality due to croup is very low.
  • Symptoms of croup are a low-grade fever with or without an upper respiratory infection-like prodrome, a characteristic “seal-like” barking cough, and inspiratory stridor, accompanied by varying degrees of respiratory distress.
  • A toxic-looking child presenting with drooling, tripod stance, and stridor with the absence of a barky cough should prompt quick assessment for epiglottitis, with airway management handled by highly skilled specialist physicians (ENT and/or anesthesiologist).
  • Diagnosis of croup should be made clinically. If imaging studies are obtained to rule out another diagnosis, patients should be closely monitored because of the risk of rapidly progressive upper airway obstruction.
  • Treatment of croup consists of oxygen by blow-by technique, oral corticosteroids (dexamethasone 0.15-0.6 mg/kg/dose) even for mild cases, and nebulized epinephrine for children with signs of upper airway obstruction (audible stridor or marked chest wall retractions). L-epinephrine 1:1000 has been shown to be as effective as racemic epinephrine 2.25%, and institutional preference may guide management.48
  • Signs of impending respiratory failure include a change in mental status, less respiratory effort, disappearance of stridor accompanied by a pale, dusky appearance, and decreasing oxygen saturation.
  • Children with significant respiratory symptoms 4 hours after the administration of corticosteroids or repeated doses of epinephrine should be admitted to the hospital.
  • Children with recurrent episodes of croup should be referred to an otorhinolaryngologist for assessment of their upper airway to rule out anatomical anomalies such as subglottic stenosis or gastroesophageal reflux.

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Last Modified: 05/23/2017
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