Materiały źródłowe

• #1 Croup: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0501/p575.html

  Croup is a common respiratory illness affecting 3% of children six months to three years of age. It accounts for 7% of hospitalizations annually for fever and/or acute respiratory illness in children younger than five years. Croup is a manifestation of upper airway obstruction resulting from swelling of the larynx, trachea, and bronchi, leading to inspiratory stridor and a barking cough. […] Laboratory studies are seldom needed for diagnosis of croup. Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended. […] Diagnosis of croup is based on clinical findings of barking cough, stridor, and hoarseness. Diagnostic testing is typically not necessary. […] Croup is primarily a clinical diagnosis, with typical findings of abrupt onset of a barking cough, inspiratory stridor, and hoarseness. Many patients will also have dyspnea and fever, but the absence of fever should not reduce suspicion for croup.

• #2 Croup: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29763253/

  Croup is a common respiratory illness affecting 3% of children six months to three years of age. It accounts for 7% of hospitalizations annually for fever and/or acute respiratory illness in children younger than five years. Croup is a manifestation of upper airway obstruction resulting from swelling of the larynx, trachea, and bronchi, leading to inspiratory stridor and a barking cough. Many patients experience low-grade fevers, but fever is not necessary for diagnosis. […] Laboratory studies are seldom needed for diagnosis of croup. Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended. Radiography and laryngoscopy should be reserved for patients in whom alternative diagnoses are suspected. Randomized controlled trials have demonstrated that a single dose of oral, intramuscular, or intravenous dexamethasone improves symptoms and reduces return visits and length of hospitalization in children with croup of any severity. In patients with moderate to severe croup, the addition of nebulized epinephrine improves symptoms and reduces length of hospitalization.

• #3 Croup: Clinical features, evaluation, and diagnosis – UpToDate

  https://www.uptodate.com/contents/croup-clinical-features-evaluation-and-diagnosis

  Croup is a respiratory illness characterized by inspiratory stridor, barking cough, and hoarseness. These symptoms result from inflammation in the larynx and subglottic airway. Although croup usually is a mild and self-limited illness, significant upper airway obstruction and respiratory distress can occur. […] The clinical features, evaluation, and diagnosis of croup will be discussed here. […] Laryngotracheitis (croup) — Croup is a respiratory illness characterized by inspiratory stridor, barking cough, and hoarseness. These symptoms result from inflammation in the larynx and subglottic airway. […] Viral croup — Viral croup (also called classic croup) refers to the typical croup syndrome that occurs most commonly in children six months to three years of age. As the name implies, it is caused by respiratory viruses and so viral symptoms (eg, nasal congestion, fever) are usually present. Viral croup is usually a self-limited illness; the cough typically resolves within three days.

• #4 Patient education: Croup in infants and children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/croup-in-infants-and-children-beyond-the-basics

  CROUP DIAGNOSIS […] Croup is usually diagnosed based upon the child’s symptoms and signs, including a barking cough and stridor. X-rays and laboratory testing usually are not needed to make the diagnosis. […] […] CROUP SYMPTOMS […] The primary symptoms of croup are a „barking cough,” hoarseness, and stridor (which is a high-pitched sound heard when breathing in). […] […] Symptoms of croup resolve in most children within two days, but the cough can persist up to one week. Complications are uncommon. […] […] For children requiring hospitalization, some may require observation for only a few hours to half a day. Others may stay in the hospital for a day or two. It is unusual to require more than a two-day hospitalization for croup. If this happens, an additional evaluation may be performed to assess for other causes of stridor and breathing difficulty. This may include X-rays and/or consultation with an ear, nose, throat specialist.

• #5 Croup: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1067.html

  The diagnosis of croup is based on clinical assessment. Abrupt onset of barking cough, hoarseness, and inspiratory stridor is highly suggestive of croup. […] Diagnosis also involves closely assessing the severity of croup by evaluating respiratory status and rate, retractions, stridor, heart rate, use of accessory muscles, and mental status. […] Laboratory and imaging evaluation are not essential, but may be used to rule out other illnesses in selected patients with an atypical or severe presentation. […] Although chest radiography cannot diagnose croup, it can rule out other pulmonary conditions when the diagnosis is unclear in a child with stridor. […] Lateral neck radiography may be considered if the diagnosis is in doubt because it could help detect epiglottitis (thickened epiglottis), retropharyngeal abscess (widening of the retropharyngeal soft tissues), and bacterial tracheitis (thickened trachea).

• #6 Croup | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/c/croup

  Croup is frightening to the child and parents. A crying, upset child tends to make the croup worse. Parents can help to relieve croup by being calm themselves, which helps to quiet the child. This relieves the tightness around the larynx and allows the child to breathe more easily. […] If your child’s breathing does not improve, call your child’s doctor or go to the nearest emergency room. […] Your child’s breathing does not improve after trying the home treatments for 15-30 minutes. Your child’s breathing problem gets worse. Your child begins drooling. Your child has trouble swallowing. Your child becomes restless and cannot sleep. A bluish color is seen around your child’s lips. […] Tell the doctor what you have seen and what you have done. This information will help the doctor care for your child.

• #7 Croup – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/681

  Croup is a common cause of acute respiratory distress in children. […] Careful history and physical exam sufficient for confirming clinical diagnosis and ruling out potentially serious differentials. […] Key diagnostic factors include symptoms increasing with agitation, distinctive seal-like barky cough, and age 6 months to 6 years. […] Other diagnostic factors include male sex, peak season late autumn (North America), prodromal symptoms, abrupt onset of symptoms, symptoms worse at night, hoarse voice, respiratory distress (sternal/intercostal indrawing, stridor), persistent agitation, lethargy, asynchronous chest wall and abdominal movement, fatigue, signs of hypoxia (pallor or cyanosis), and signs of hypercapnia (decreased level of consciousness secondary to rising PaCO). […] 1st tests to order include clinical exam. […] Investigations to avoid include viral panel testing and x-ray neck.

• #8 Croup: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1067.html

  Croup is a common illness responsible for up to 15 percent of emergency department visits due to respiratory disease in children in the United States. Croup symptoms usually start like an upper respiratory tract infection, with low-grade fever and coryza followed by a barking cough and various degrees of respiratory distress. […] Croup is often caused by viruses, with parainfluenza virus (types 1 to 3) as the most common. However, physicians should consider other diagnoses, including bacterial tracheitis, epiglottitis, foreign body aspiration, peritonsillar abscess, retropharyngeal abscess, and angioedema. […] A single dose of dexamethasone (0.15 to 0.60 mg per kg usually given orally) is recommended in all patients with croup, including those with mild disease. Nebulized epinephrine is an accepted treatment in patients with moderate to severe croup.

• #9 Croup – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431070/

  Croup is a common respiratory illness of the trachea, larynx, and bronchi that can lead to inspiratory stridor and barking cough. […] Croup is primarily a clinical diagnosis. Potentially life-threatening conditions such as epiglottitis or a foreign body in the airway must be ruled out first. […] Croup is typically a clinical diagnosis based on signs and symptoms. […] The most commonly used system for classifying the severity of croup is the Westley score ranging from 0 to 17 points divided by five factors: stridor, retractions, cyanosis, level of consciousness, and air entry. […] Westley score less than or equal to 2 indicates mild croup. […] Westley score between 3 to 5 indicates moderate croup. […] Westley score between 6 to 11 indicates severe croup, and a score greater than 12 indicates impending respiratory failure.

• #10 Pediatric Croup: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/pediatric-croup/?srsltid=AfmBOoqcLWRqDTGVs8N7BqgQ2I4eUBTT3Qkh3XQ80s8phdeSIA1i2UU7

  Croup is often diagnosed based on clinical presentation. Because of the barking style of the cough, it is usually apparent to the clinician. […] If the diagnosis is unclear, the child should have anteroposterior and lateral x-rays of the neck and chest taken. Subepiglottic narrowing (steeple sign) is detected to confirm a diagnosis. […] Clinicians should perform pulse oximetry on all children who present with croup. Those with respiratory distress should have arterial blood gas measurements taken. […] In addition to pulse oximetry, the clinician may order laboratory tests including: CBC w/diff, throat culture to r/o bacterial cause, rapid antigen tests. […] The Westly Croup Scale is a tool that can assist clinicians in determining the severity of croup. Scores range from 0 to 17 based on the following factors: stridor, retractions, cyanosis, level of consciousness, airway entry.

• #11 Croup – Wikipedia

  https://en.wikipedia.org/wiki/Croup

  Croup is typically diagnosed based on signs and symptoms. […] The first step is to exclude other obstructive conditions of the upper airway, especially epiglottitis, an airway foreign body, subglottic stenosis, angioedema, retropharyngeal abscess, and bacterial tracheitis. […] A frontal X-ray of the neck is not routinely performed, but if it is done, it may show a characteristic narrowing of the trachea, called the steeple sign, because of the subglottic stenosis, which resembles a steeple in shape. […] Other investigations (such as blood tests and viral culture) are discouraged, as they may cause unnecessary agitation and thus worsen the stress on the compromised airway. […] Croup is usually deemed to be due to a viral infection. […] The most commonly used system for classifying the severity of croup is the Westley score.

• #12 Pediatric Croup: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/pediatric-croup/?srsltid=AfmBOoqcLWRqDTGVs8N7BqgQ2I4eUBTT3Qkh3XQ80s8phdeSIA1i2UU7

  Each item is scored from 0 to 5, depending on the category, and totaled. The score indicates severity level: A score of or = 2 indicates mild croup. A score of 3 to 5 indicates moderate croup. A score of 6 to 11 indicates severe croup. A score of 12 indicates respiratory failure is imminent. […] Based on the score, the clinician can then determine the best course of treatment/management.

• #13 Croup – Wikipedia

  https://en.wikipedia.org/wiki/Croup

  The points given for each factor is listed in the adjacent table, and the final score ranges from 0 to 17. […] A total score of 2 indicates mild croup. […] A total score of 35 is classified as moderate croup. […] A total score of 611 is severe croup. […] A total score of 12 indicates impending respiratory failure.

• #14 Croup: Symptoms and Treatment | Doctor

  https://patient.info/doctor/croup-pro

  If hospital admission is not required (mild illness): […] Prescribe a single dose of oral dexamethasone (0.15 mg/kg) to be taken immediately. Glucocorticoids reduce symptoms of croup at two hours, shorten hospital stays and reduce the rate of return visits to care. […] The Westley scoring system may also be used. […] A Westley score less than or equal to 2 indicates mild croup (more than 85% of children with croup fall into this category). A Westley score between 3 to 5 indicates moderate croup. A Westley score between 6 to 11 indicates severe croup, and a score greater than 12 indicates impending respiratory failure. […] In most cases of moderate croup, symptoms resolve without significant complications. […] With dexamethasone and nebulised epinephrine combination treatment, the prognosis for severe croup is excellent.

• #15 Croup: diagnosis and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/croup-diagnosis-and-management

  Croup is a largely a clinical diagnosis and involves assessing presence and the severity of symptoms using the Westley Croup Score and evaluating respiratory status and rate, retractions, stridor, heart rate, use of accessory muscles and mental status. The most reliable indicators for assessing severity are the presence of stridor and the extent of retractions. […] Patients with red-flag symptoms or symptoms that began abruptly and cause parental concern may present at hospital emergency department. […] Laboratory and imaging evaluations are not necessary but can be useful in ruling out other illnesses in children with atypical or severe presentations. […] Children with mild croup can typically be discharged home after a single dose of dexamethasone. Those with moderate croup should be observed for at least four hours after receiving dexamethasone and then re-assessed to ensure symptom stability.

• #16 Croup: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0501/p575.html

  Laboratory studies are seldom needed to diagnose croup. Viral cultures and rapid antigen testing should be reserved for patients in whom initial treatment is ineffective. […] Although radiographic imaging is not routinely indicated, croup is often associated with the steeple sign, which indicates glottic and subglottic narrowing. However, this finding is neither specific nor sensitive for croup and may be present in patients with epiglottitis, bacterial tracheitis, neoplasm, or thermal injury. […] Corticosteroids should be used in patients with croup of any severity. Treatment with dexamethasone results in faster resolution of symptoms and decreased return to medical care. […] Epinephrine decreases symptom scores in children with moderate or severe croup and should be given at the recommended dose of 0.05 mL per kg of racemic epinephrine 2.25% (maximum dose = 0.5 mL) or 0.5 mL per kg of L-epinephrine 1:1,000 via nebulizer (maximum dose = 5 mL).

• #17 Croup Workup: Approach Considerations

  https://emedicine.medscape.com/article/962972-workup

  Croup is primarily a clinical diagnosis, with the diagnostic clues based on presenting history and physical examination findings. […] Laboratory test results rarely contribute to confirm diagnosis. The complete blood cell (CBC) count is usually nonspecific, although the white blood cell (WBC) count and differential may suggest a viral etiology with lymphocytosis. Identifying the specific viral etiology (eg, parainfluenza virus type) via nasal washings is typically not necessary, but may be useful to determine isolation needs in the hospital care setting or, in the case of influenza A, to decide whether antiviral therapy should be initiated. […] Most importantly, croup is a clinical diagnosis. Radiographs can be used as a tool to help confirm this diagnosis, but are not required in uncomplicated cases. […] A steeple sign may also be observed in patients without croup, which warrants other differential considerations for this radiographic finding, such as epiglottitis, thermal injury, angioedema, or bacterial tracheitis.

• #18 Croup – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/croup/

  Laryngoscopy/bronchoscopy: may be performed for suspected foreign bodies or atypical croup. […] Respiratory viral panel is usually reserved for patients who do not respond to initial treatment. […] CBC may help distinguish between bacterial and viral infections. […] Blood gas is indicated for severe respiratory symptoms, e.g., signs of impending respiratory failure.

• #19 Croup – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/croup/

  Croup is primarily a clinical diagnosis, and diagnostic studies are only performed for severe disease, diagnostic uncertainty, or recurrent episodes of croup. […] Croup is most commonly diagnosed based on the presence of characteristic clinical features of croup. […] Diagnostic studies are not routinely required; do not delay treatment in unstable patients to obtain studies. […] Indications for diagnostic studies include: atypical presentation or diagnostic uncertainty, to rule out differential diagnoses of stridor, severe disease, recurrent episodes of croup. […] X-ray chest and neck (anteroposterior and lateral) may identify subglottic narrowing; on anteroposterior view (steeple sign). […] CT chest and neck: usually performed for differential diagnoses or suspected underlying congenital abnormalities.

• #20 Croup – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/croup

  Children with croup are usually diagnosed based on a clinical examination. […] Your physician may listen to your child’s breathing with a stethoscope for wheezing and decreased breath sounds. […] X-rays of the neck or chest are the initial imaging choice for assisting in diagnosis and excluding other potential causes of similar symptoms such as a swallowed object that is blocking the airway. […] X-rays of pediatric patients with croup often show a tapering or narrowing of the airway below the vocal cords. This pattern is known as „the steeple sign” because its inverted V shape is reminiscent of a church steeple.

• #21 Croup – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431070/

  Treatment depends on the severity based on the Westley croup score. […] Croup is most commonly a viral disease. Antibiotics are reserved for cases when primary or secondary bacterial infection is suspected. […] Differential diagnosis includes bacterial tracheitis, epiglottitis, foreign body aspiration, hemangioma, peritonsillar abscess, neoplasm, retropharyngeal abscess, and smoke inhalation. […] Croup is a self-limited disease, with most cases resolving within a few days. Uncommon complications may include bacterial tracheitis, pneumonia, pulmonary edema, and rarely, death.

• #22 Croup Differential Diagnoses

  https://emedicine.medscape.com/article/962972-differential

  Although croup is considered the most common cause of stridor and respiratory distress in the pediatric population, diagnostic differentials should be considered, dependent on clinical history and presenting symptoms, and include the following: […] Gastroesophageal reflux (diagnostic consideration for recurrent croup) […] Rarer etiologies in the pediatric population: Laryngeal tuberculosis, neoplasm (compressing trachea), sarcoidosis, Wegener granulomatosis.

• #23 Recurrent croup | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/recurrent-croup

  Many babies and toddlers will have a bout of croup, also known as laryngotracheitis, when an infection causes a narrowing in their throat that leads to a high-pitched noise heard when a child breathes in (called stridor) and a barking cough. It usually lasts a few days and almost always less than a week. […] If a child has repeated bouts of croup, more than two episodes a year, they are said to have recurrent croup. […] Recurrent and atypical croup are not diagnoses in and of themselves. They are a signal that there may be another underlying disease or condition. […] Signs and symptoms that may warrant further evaluation: more than two episodes of croup per year, illness that seems to be nearly gone, only to come back with symptoms lasting several weeks, little or no response to standard croup therapies, occurring outside of the usual age range of 6 months to 3 years.

• #24 Croup (Laryngotracheobronchitis) | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816944/all/Croup__Laryngotracheobronchitis_

  Infection of the larynx, trachea, and bronchi, causing narrowing of the airway secondary to inflammation and edema. […] Typically, caused by viruses that infect oropharyngeal mucosa and migrates inferiorly; most common pathogen is parainfluenza virus, responsible for 80% of cases. […] Spasmodic croup cause is unclear, possibly allergy, airway hyperactivity, and gastroesophageal reflux. […] Prior intubations, structural airway abnormality, prematurity, and age 3 years increase the risks for recurrent croup (more than two episodes per year). […] Croup spreads through droplets. Children should be considered contagious up to 3 days after the start of illness and/or until afebrile. There is no specific vaccine for croup, but seasonal influenza vaccine may contribute to decreased risk. […] If recurrent (more than two episodes in a year) or during the first 90 days of life, consider host factors or allergic factors. […] Consider gastroesophageal reflux disease diagnostic consideration for patients with recurrent croup symptoms.

• #25 Recurrent croup | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/recurrent-croup

  Sometimes recurrent croup signals an abnormality in the throat or airway, either that the child was born with (congenital) or due to an injury. […] To check for these types of abnormalities, a child might undergo a triple scope procedure which consists of a flexible bronchoscopy, a rigid bronchoscopy and an esophagogastroduodenoscopy. […] The specific treatment depends on the underlying diagnosis. […] Many of the conditions that cause recurrent croup can be repaired, and the child will no longer experience croup-like symptoms. Other diagnoses are chronic conditions that can be managed by medications and/or dietary changes.

• #26 Croup

  https://emed.ie/Paediatrics/Respiratory/Croup.php

  Croup is a viral illness with inflammation of the upper airway. It is also known as acute viral laryngo-tracheo-bronchitis. […] Investigations are usually not necessary. […] Croup is less common in children less than 6 months of age. All children 6 months of age with new onset stridor should have a review by a senior clinician prior to discharge with strong consideration for an emergent ENT review, especially for children 3 months of age. […] Hypoxia is a late sign indicates severe croup. […] If 6 months of age consider: Laryngomalacia, Subglottic haemangioma, Vascular ring, Laryngotracheomalacia, Vocal cord abnormality, Other congenital airway anomaly. […] Manage in Resusc. room record case in the log please. […] Any of hypoxia/altered mental state/paradoxical breathing / poor response to adrenaline nebuliser contact paediatric anaesthesia to arrange emergent gaseous induction for intubation. This is a life threatening situation. […] Indicators of increasing severity: Increasing respiratory rate, Increasing stridor, air entry on auscultation, Cyanosis at rest with O2 sats. 95% in air, level of consciousness. […] At risk are prone to more severe croup and admission should be considered even with mild symptoms.

• #27 Croup – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/croup/symptoms-causes/syc-20350348

  Croup is usually caused by a viral infection, most often a parainfluenza virus. […] Contact your child’s health care provider if symptoms are severe, worsen, last longer than 3 to 5 days or aren’t responding to home treatment. […] Most cases of croup are mild. In a small number of children, the airway swells enough to cause problems with breathing. Rarely, a bacterial infection of the windpipe can occur in addition to the viral infection. This can result in trouble breathing and requires emergency medical care. […] Only a small number of children seen in the emergency room for croup require a stay in the hospital.

• #28 Croup – Diagnosis – Management – TeachMePaediatrics

  https://teachmepaediatrics.com/respiratory/upper-respiratory-tract/croup/

  Once calculated, children can be categorised into 1 or 4 levels of severity: Mild (score 0-2), Moderate (score 3-5), Severe (score 6-11), Impending respiratory failure (score 12-17). […] Diagnosis is normally a clinical decision. […] For any additional tests it is important to consider the distress that these could cause the child. […] Most children with mild croup can be managed at home but consider admission in the following cases: Previous history of severe airway obstruction, 6 months of age, Immunocompromised, Have had inadequate fluid intake, Have had a poor response to initial treatment, The diagnosis is uncertain, There is significant parental anxiety. […] Immediate hospital admission should occur if: The child has moderate/severe croup or impending respiratory failure. […] For all children with croup give a single dose of oral dexamethasone (0.15mg/kg body weight) or oral prednisolone (1-2mg/kg body weight). […] Complications are rare and the majority of children do not need hospitalisation. In children that are intubated the mortality rates are less than 0.5%.

• #29 Consensus Guidelines for Management of Croup: Northern California Pediatric Hospital Medicine Consortium – UCSF Pediatrics

  https://medconnection.ucsfbenioffchildrens.org/croup-guidelines

  Routine lab testing (including respiratory viral testing) NOT recommended. […] Routine imaging (CXR or lateral neck x-ray) NOT recommended. […] Croup symptoms mild or improved from presentation. […] Able to maintain adequate hydration. […] Received dexamethasone. […] Persistent moderate symptoms after Dexamethasone racemic epinephrine. […] Persistent severe croup symptoms despite therapy. […] There is no evidence to suggest that croup symptoms, on average, worsen after the treatment effect of nebulized epinephrine dissipates. […] Dexamethasone: single PO dose. […] Administer for all patients with croup (regardless of severity). […] No evidence supports repeated doses of dexamethasone. […] For severe or atypical cases, repeat steroid doses may be considered; consultation with pediatric subspecialists (PICU, ENT) is recommended.

• #30 EMNote.org – EMNote

  https://www.emnote.org/emnotes/croup-diagnosis-and-management

  Nebulized racemic epinephrine helps reduce airway swelling and improve breathing. […] Oxygen therapy may be required for children with severe croup and respiratory distress. […] Routine laboratory testing, including respiratory viral testing, is not recommended. […] Admission criteria for croup include: persistent stridor at rest after Dexamethasone racemic epinephrine, inadequate hydration, need for supplemental oxygen, atypical presentations, concerns for alternative diagnoses, escalating stridor at rest, or need for emergency intubation, such as cyanosis or hypoxemia despite supplemental oxygen, bradypnea or poor respiratory effort, along with altered mental status. […] In conclusion, croup management involves accurate diagnosis, supportive care, and appropriate use of medications such as oral dexamethasone and nebulized epinephrine.

• #31 Viral croup: Current diagnosis and treatment

  https://www.contemporarypediatrics.com/view/viral-croup-current-diagnosis-and-treatment

  The decision to intubate is based on clinical criteria that include increasing stridor, respiratory rate, heart rate, retractions, the appearance of cyanosis, exhaustion, confusion, or a failure to respond to nebulized epinephrine. […] There are different levels of care for patients with viral croup, depending on their clinical presentation.

• #32 Croup | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/croup/

  Clinicians should treat patients with croup based on the severity of the illness. All infants and children with croup should be treated with corticosteroids. […] Corticosteroid therapy has demonstrated efficacy and should be considered for all patients with croup, regardless of severity. […] Dexamethasone is typically the corticosteroid of choice. […] Children with moderate to severe croup (Westley Croup Score 3 or higher) should be treated with a single dose of dexamethasone, 0.15 to 0.60 mg/kg orally or parenterally. […] If the patient improves after treatment with dexamethasone and epinephrine and are stable with no stridor, they may be released.

• #33 Croup: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1067.html

  The optimal type of corticosteroid, route of administration, and dose are unclear. Oral and intramuscular administration provide similar degrees of benefit, and both are equivalent or superior to inhaled corticosteroids. […] Corticosteroid therapy benefits patients with croup presumably by decreasing edema in the laryngeal mucosa, and is usually effective within six hours of treatment.

• #34 Croup – Don’t Forget the Bubbles

  https://dontforgetthebubbles.com/croup/

  Viral laryngotracheobronchitis is essentially inflammation around the main large breathing structures, usually caused by parainfluenza 1 + 3. Other respiratory viruses, including SARS-CoV-2 and RSV, may also be involved. This inflammation causes a tell-tale cough and noisy breathing due to the obstruction to flow. […] Croup is a self-limiting viral illness, and treatment tends to look to a short-term reduction in inflammation to improve the work of breathing. […] If the child can take the medication, dexamethasone or prednisolone should be given to all cases of croup where any stridor or increased effort in breathing is present. […] Dexamethasone appears to be more efficacious than prednisolone. […] Prednisolone tends to be favoured in primary care at a 1mg/kg dose with two additional daily doses.

• #35 Acute management of croup in the emergency department | Canadian Paediatric Society

  https://cps.ca/documents/position/acute-management-of-croup

  Croup is one of the most common causes of upper airway obstruction in young children. […] Published guidelines for the diagnosis and treatment of croup advise using steroids as the mainstay treatment for all children who present to emergency department (ED) with croup symptoms. […] The clinical benefit of corticosteroids in croup is well established and should be considered for treating all children presenting with croup and symptoms ranging from mild to severe. […] Improvement generally begins within 2 to 3 hours after a single oral dose of dexamethasone and persists for 24 to 48 hours. […] Overall, children treated with corticosteroids have fewer return visits or admissions to the hospital. […] In children with moderate to severe croup treated with corticosteroids, there was a reported average reduction of 12 hours in length of stay in the ED or hospital.

• #36 Croup: What It Is and How to Treat It

  https://www.uspharmacist.com/article/croup-what-it-is-and-how-to-treat-it-41766

  Croup treatment is based upon disease severity. Croup can be mild in nature and may even resolve without medical attention; however, if left untreated, severe cases can eventually lead to respiratory failure. […] The generally accepted dosage of dexamethasone for the management of croup is 0.6 mg/kg administered as a single dose. […] An improvement in croup symptoms following corticosteroid administration is anticipated to occur within 4 to 6 hours. […] The use of nebulized racemic epinephrine has been demonstrated to improve symptoms of croup within 10 to 15 minutes of administration. […] Since the causative organism in croup is always viral, antibiotics are generally not warranted. […] Cough suppressants are not effective against croup. These products should not be recommended for the treatment of croup. […] Clinical trials have demonstrated no benefit to this practice, and it is no longer recommended.

• #37 Acute management of croup in the emergency department | Canadian Paediatric Society

  https://cps.ca/documents/position/acute-management-of-croup

  Nebulized epinephrine is recommended for moderate to severe croup. […] The first prospective trial assessing safe discharge after treating paediatric outpatients with a combination of dexamethasone and nebulized epinephrine, and including observation for 2 to 4 hours, supported the safety of this measure. […] A heliox or helium-oxygen mixture can reduce respiratory distress in children with severe croup. […] The use of antibiotics and short-acting beta-2-agonist bronchodilators in children with typical croup are rarely indicated because of the low incidence of bacterial infection.

• #38 Croup

  https://www.seattlechildrens.org/conditions/a-z/croup/

  Croup is a viral infection of the voicebox (larynx) […] The croupy cough is tight, low-pitched, and barky (like a barking seal) […] Stridor is a harsh, raspy tight sound best heard with breathing in […] Loud or constant stridor means severe croup. So does stridor at rest (when not crying or coughing) […] All stridor needs to be treated with warm mist […] Most children with stridor need treatment with a steroid (such as Decadron) […] Viral Croup. Viruses are the most common cause of croup symptoms. Many respiratory viruses can infect the vocal cord area and cause narrowing […] Croup symptoms can also be caused by a food allergy. This can be life-threatening (anaphylaxis) […] Stridor (harsh sound with breathing in) is heard now […] Trouble breathing, but not severe […] Stridor (harsh sound with breathing in) occurred but not present now

• #39 Croup (Laryngotracheobronchitis)

  https://www.rch.org.au/clinicalguide/guideline_index/croup_laryngotracheobronchitis/

  Croup is inflammation of the upper airway, larynx and trachea, usually triggered by a virus, most commonly parainfluenza as well as other respiratory viruses including COVID-19 (apply appropriate infection control) […] Croup is a clinical diagnosis. Investigations such as respiratory swab or nasopharyngeal aspirate, X-rays and blood tests are not indicated in typical presentations. Consider appropriate investigations if there is concern for differential diagnoses as above […] Children can be discharged home once stridor free at rest […] Parents should be advised to seek medical attention if recurrence of stridor at rest despite having received oral steroids […] Antibiotics have no role in uncomplicated croup as it has a viral aetiology […] Anti-tussives such as codeine have no proven effect on the course or severity of croup, and may cause respiratory depression and increase sedation.

• #40 Consensus Guidelines for Management of Croup: Northern California Pediatric Hospital Medicine Consortium – UCSF Pediatrics

  https://medconnection.ucsfbenioffchildrens.org/croup-guidelines

  Croup (laryngotracheobronchitis) is a viral illness, most common in late fall to early winter, leading to inflammation of the upper airway. […] Symptoms: Sudden onset of barky cough, inspiratory stridor, hoarse voice, +/- Antecedent URI symptoms, +/- Fever, +/- Respiratory distress. […] Consider alternative diagnoses in patients with atypical or severe clinical presentation, or those with poor response to standard treatments. […] Do not routinely order laboratory testing (including viral testing). […] Do not routinely order x-rays. […] Administer Dexamethasone to all patients with a diagnosis of croup, regardless of symptom severity. […] Discharge patients meeting the following criteria: No or minimal stridor at rest, No or minimal work of breathing, Able to talk and feed without difficulty, 2 hours from last racemic epinephrine treatment, No supplemental oxygen requirement.

• #41 Croup

  https://www.seattlechildrens.org/conditions/a-z/croup/

  Croup is a frequent problem (3 or more times) […] Most children with croup just have a barky cough […] Some have tight breathing (called stridor). Stridor is a loud, harsh sound when breathing in. It comes from the area of the voicebox […] Call Your Doctor If: Trouble breathing occurs […] Stridor (harsh raspy sound) occurs […] Croupy cough lasts more than 14 days […] You think your child needs to be seen […] Your child becomes worse.

• #42 Croup: A-to-Z Guide from Diagnosis to Treatment to Prevention | DrGreene

  https://www.drgreene.com/articles/croup

  Children with croup are usually diagnosed based on history and physical. A brassy cough that sounds like a seal barking is the hallmark of croup. […] Croup is typically much worse at night. […] Croup often lasts 5 or 6 nights, but the first night or two are usually the most severe. Rarely, croup can last for weeks. Croup that lasts longer than a week or that recurs frequently should be discussed again with your doctor to determine the cause. […] Children with croup are usually diagnosed based on the history and physical exam. Sometimes a doctor will even identify croup by listening to a child cough over the phone. Occasionally other studies, such as x-rays, are needed.

• #43 Croup – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/681

  Croup is a common cause of acute respiratory distress in children. […] Careful history and physical examination sufficient for confirming clinical diagnosis and ruling out potentially serious differentials. […] Key diagnostic factors include symptoms increasing with agitation, distinctive seal-like barky cough, and age 6 months to 6 years. […] Clinical exam is the 1st investigation to order.

• #44 Diagnosis and management of croup in children

  https://www.contemporarypediatrics.com/view/diagnosis-and-management-croup-children/1000

  The severity of respiratory distress is key to an accurate differential diagnosis as well as appropriate management, so assessment of the degree of airway obstruction is critical in the initial assessment. […] For children who present with severe respiratory symptoms not from viral croup, other diagnostic imaging and lab work may be helpful along with the history and physical examination to make the differential diagnosis. […] Standard treatment for all cases of croup regardless of severity is treatment with a single dose of a corticosteroid, with the addition of nebulized adrenaline for children with more moderate to severe disease. […] Most children with croup will not need to be seen in the ED or need hospitalization. However, recognizing the signs and symptoms of more acute illness that does require hospitalization is important to reduce the number of unnecessary ED visits and hospitalizations.

• #45 Croup: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/8277-croup

  Croup is a respiratory infection that affects young children. Croup causes swelling of your child’s voice box (larynx) and windpipe (trachea). This swelling causes the airway below their vocal cords to narrow, which makes their breathing noisy and difficult. […] You can usually tell if your child has croup based on their signs and symptoms. The most common symptoms are a barking cough and stridor. […] Croup treatment depends on the severity of your child’s condition and the risk of it rapidly worsening. […] For moderate to severe croup, you should take your child to the nearest urgent care center or emergency room (ER). Severe croup can be life-threatening, and you shouldn’t delay taking your child in. […] If your child develops symptoms of severe or worsening croup, seek immediate medical attention. These symptoms include difficulty breathing, blue-tinged skin (cyanosis), severe coughing spells, drooling or difficulty swallowing, inability to cry or speak due to trouble taking a breath, a noisy, high-pitched whistling sound while breathing, and sucking in the skin around your child’s ribs and the top of their breastbone (retractions).

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