Overview

• URTI affecting children aged 6 months - 6 years (peak 2 years old). Causes oedema in the larynx.
  • Caused by parainfluenza virus.
  • More common in autumn.
  • ‘Laryngeotracheobronchitis’

Making Diagnosis

Clinical Features

• Harsh stridor (’harsh vibrating noise on inspiration’ - due to inflamed/oedmatous airways, causes subglottic airway narrowing).
• ‘Barking cough’.
• Hoarse voice.
• Fever.

Investigations

• Primarily a clinical diagnosis.
• CXR → subglottic narrowing (’steeple sign’).
• Never perform a throat examination on a patient with croup due to risk of airway obstruction!!

Management Plan

• Admission → moderate/severe croup, <3 months old, RR>60.
• ALL SEVERITIES → oral dexamethasone (single dose 0.15 mg/kg) to be taken immediately. (If too unwell to receive in GP → give nebulised budesonide or IM dexamethasone as alternatives).

  • Mild → admission not required. Advise parents if any stridor, intercostal recessions, or cyanosis to bring to A&E immediately.

    • Occasional barking cough with no stridor at rest
    • No or mild recessions
    • Well looking child

  • Moderate (admit) → oxygen.

    • Frequent barking cough and stridor at rest
    • Recessions at rest
    • No distress

  • Severe (admit) → oxygen + nebulised adrenaline.

    • Prominent inspiratory stridor at rest
    • Marked recessions
    • Distress, agitation or lethargy (+ marked respiratory distress)
    • Tachycardia/Hypoxic

    <aside> 💡 Mild (oral dex): no stridor at rest, Moderate (+ nebulised adrenaline): stridor at rest + no agitation or lethargy, Severe (+ oxygen): stridor at rest + agitation or lethargy.

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