Overview
Croup, or laryngotracheobronchitis, is a viral respiratory condition characterized by a barking cough, stridor, and upper airway obstruction, predominantly affecting children aged 6 months to 3 years. 2Diagnosis
Clinical Presentation: Barking cough, inspiratory stridor, and hoarseness.
Diagnostic Tests: No specific diagnostic tests; clinical assessment is primary.
Grading: Utilize clinical scoring systems like the 2-item Telephone Out Patient score (barky cough and stridor) assessed over 3 days 2.
Special Evaluations: Consider coordinated aerodigestive endoscopy for recurrent cases to identify underlying conditions such as bacterial infections, tracheomalacia, or subglottic stenosis 1.Management
First-Line Treatments:
- Steroids: Oral dexamethasone (0.15 mg/kg) or prednisolone (1 mg/kg) recommended for moderate to severe croup 3.
- Adrenaline (Epinephrine): Particularly for severe cases or life-threatening croup 3.
Adjunctive Treatments:
- Humidified Air: Limited evidence supporting efficacy; marginal benefits observed in some studies 4.
- Nebulized Steroids: Potential role in reducing hospitalization needs, though not universally recommended 6.Special Populations
Premature Infants: Higher association with subglottic stenosis in recurrent croup cases 1.
Pregnancy: Maternal smoking during pregnancy correlates with lower IQ scores in children, potentially impacting respiratory health 6.Key Recommendations
Use Steroids for Croup Management: Administer oral dexamethasone (0.15 mg/kg) or prednisolone (1 mg/kg) for moderate to severe croup episodes (Evidence: Strong 3).
Consider Adrenaline for Severe Cases: Administer adrenaline for severe or life-threatening croup (Evidence: Strong 3).
Evaluate Recurrent Cases Thoroughly: Perform coordinated aerodigestive evaluations in recurrent croup to identify underlying pathologies (Evidence: Moderate 1).
Monitor with Scoring Systems: Utilize simple clinical scoring systems like the 2-item Telephone Out Patient score for follow-up assessments (Evidence: Moderate 2).
Avoid Routine Chest Radiographs Unless Indicated: Limit unnecessary imaging, especially in routine management (Evidence: Moderate 5).
Address Maternal Smoking: Screen and counsel mothers on smoking cessation to mitigate long-term respiratory impacts on children (Evidence: Weak 6).References
1 Chen X, Pereira N, Graw-Panzer K, Ciecierega T, Maresh AM. Aerodigestive Approach in Evaluating Pediatric Patients With Recurrent Croup. The Annals of otology, rhinology, and laryngology 2025. link
2 Bjornson CL, Williamson J, Johnson DW. Telephone Out Patient Score: The Derivation and Validation of a Telephone Follow-up Assessment Tool for Use in Clinical Research in Children With Croup. Pediatric emergency care 2016. link
3 Borland ML, Babl FE, Sheriff N, Esson AD. Croup management in Australia and New Zealand: a PREDICT study of physician practice and clinical practice guidelines. Pediatric emergency care 2008. link
4 Moore M, Little P. Humidified air inhalation for treating croup: a systematic review and meta-analysis. Family practice 2007. link
5 Hampers LC, Faries SG. Practice variation in the emergency management of croup. Pediatrics 2002. link
6 Andrews JS, DeAngelis CD. Pediatrics. JAMA 1995. link
7 Laufer P. The relationship of respiratory allergies to croup. The Journal of asthma : official journal of the Association for the Care of Asthma 1986. link