Background
-Viral URI. Parainfluenza is the most common cause
-Croup is common amongst children ages 6 to 36 months although it can present between 6 months and 12 years.
Diagnosis
H&P:
-Triad of hoarse voice, barking cough, and inspiratory stridor.
–Westley Croup Score to quantify croup severity.
-X-ray shows the classic “Steeple sign”. However, x-rays are not required to establish a diagnosis.
–X-ray neck soft tissue r/o epiglottitis: Mild subglottic narrowing of the trachea which can be seen in the setting of croup.
DDx:
Treatment
The decision to admit vs. treat as outpatient based on the severity of croup.
A single dose of oral dexamethasone recommended in all pts with croup (including those with mild disease).
There is possible benefit from nebulized racemic epinephrine for moderate to severe croup.
Tylenol PRN for fever
Regular diet and keep patient hydrated
Croup pearls and links
- Dexamethasone 0.15-0.60 mg/kg PO x 1. Max 20mg/dose. May use 0.15 to 0.3 mg/kg PO x 1 for mild-to-moderate croup and 0.6 mg/kg PO x 1 for severe croup. Give with food.
- No evidence to support the use of humidification or a helium-oxygen mixture for croup patients.
- Toxic appearance, wheezing, drooling, and difficulty swallowing are symptoms that are NOT consistent with croup. “Consider bacterial tracheitis in an ill-appearing child with croup-like symptoms. (2) The vast majority (>80%) of children presenting to the ED with croup have a mild disease; severe croup is rare (<1%).” MdCalc.com
Sample from our archives
2-year-old previously healthy female with a cc of a barking cough. She presented to the ED with a 3-day history of a barking cough that started after a week of a dry cough and runny nose. Patient has taken two doses Amoxicillin and Dimetapp from PCP. She was brought to the ED early because her barking cough continued and she was also having stridor and difficulty breathing. In the ED, CXR was done and the patient was given one dose of Dexamethasone at 6mg, racemic epinephrine breathing treatments, and admitted for observation. Patient has been saturating well and hasn’t needed oxygen.
Sibling is a sick contact.
No fever, chills, c/o of headaches, history of asthma, dogs or cats at home, or smoking by parents. He has not had any sneezing, watery or red eyes. No c/o ear pain.
References / Further Reading
Cochrane Database Syst Rev. 2011 Jan 19;(1):CD001955. Glucocorticoids for croup. https://www.ncbi.nlm.nih.gov/pubmed/21249651
Am Fam Physician 2011;83(9):1067-1073.
Johnson DW: Croup. Am Fam Physician 2016;94(6):476-478. http://www.aafp.org/afp/2016/0915/p476.html