Croup is a viral illness with inflammation of the upper airway. It is also known as acute viral laryngo-tracheo-bronchitis.
- Viral prodrome (1-2 days corryzal symptoms).
- Harsh barking cough.
- Hoarse voice and stridor.
- Fever <38°.
- Stridor worse on crying and worse at night.
- Sternal recession.
- Tracheal tug.
- Cyanosis on crying.
- Continuous harsh sound.
- Caused by obstruction in the larynx and trachea.
- Predominantly an inspiratory .
- Expiratory component may be present
? subglottic lesion.
- Higher incidence in children than in adults (anatomical differences).
Differential diagnosis of stridor
- Acute laryngo-tracheo-bronchitis(croup).
- Acute epiglottitis.
- Bacterial tracheitis.
- Foreign body.
- Acute angioneurotic oedema(anaphylaxis).
- Expanding mediastinal mass.
- Peritonsillar or retropharyngeal abscess.
- General supportive measures, gentle handling and reassurance.
- Oral Dexamethasone (150 microgrammes /kg).
- Hydration should be assured by allowing the parents to feed the child.
- Investigation should be kept to a minimum.
- No lateral neck radiographs.
- Consider resusc. room.
- Oxygen if any hypoxia.
- Oral Dexamethasone (150 microgrammes /kg) (nebulised budesonide 2mg if not tolerating po Dex).
- Nebulised Adrenaline[Epinephrine] (5mls of 1 in 1,000) with cardiac monitor.
- If nebulised Adrenaline has been given, please obtain IV access and request paediatric admission.
Indicators of increasing severity (needs admission):
- Increasing respiratory rate.
- Increasing stridor.
- ↓ air entry on auscultation.
- Cyanosis at rest with O2 sats. <95% in air.
- Δ level of consciousness.
- pre-existing narrowing of the upper airways (eg. subglottic stenosis congenital or 2° to neonatal ventilation) or
- children with Down Syndrome
are prone to more severe croup and admission should be considered even with mild symptoms.