Croup

Question 1

What is croup?

Answer 1

Croup (aka laryngotracheobronchitis) = is an respiratory tract infection , which obstructs breathing and causes a characteristic barking cough seen in infants and toddlers

=> causes stridor which is caused by a combination of laryngeal oedema and secretions.

Question 2

What causes croup?

Answer 2

Parainfluenza virus in marjority

Question 3

Croup:

Peak incidence at 6 months - 3 years

More common in autumn

Answer 3

INFO CARD

Question 4

What are the features of croup?

Answer 4

Stridor

Barking cough (worse at night)

Fever

Coryzal symptoms

Question 5

Croup can be graded into mild, moderate and severe. What are the features of mild croup?

Answer 5

=> occasional barking cough

=> no audible stridor at rest

=> no / mild suprasternal ± intercostal recession

=> child is happy & prepared to eat, drink and play

Question 6

Croup can be graded into mild, moderate and severe. What are the features of moderate croup?

Answer 6

=> frequent barking cough

=> easily audible stridor at rest

=> suprasternal & sternal wall retraction at rest

=> no / little distress or agitation

=> child can be placated and is interested in its surroundings

Question 7

Croup can be graded into mild, moderate and severe. What are the features of severe croup?

Answer 7

=> frequent barking cough

=> prominent inspiratory (and occasionally, expiratory) stridor at rest

=> marked sternal wall retractions

=> significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)

=> tachycardia occurs with more severe obstructive symptoms and hypoxaemia

Question 8

Any child with moderate or severe croup should be admitted. Other features that prompt admission:

• <6 months of age
• known upper airway abnormality i.e. laryngomalacia, Down’s syndrome
• uncertainty about diagnosis (important differentials include acute epiglottis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)

Answer 8

INFO CARD

Question 9

Croup is mostly a clinical diagnosis. However, if needed what is the investigation for croup?

Answer 9

X-ray:
=> P/A view shows subglottilc narrowing = steeple sign

=> lateral view in acute epiglottis will show swelling of epiglottis = thumb sign

Question 10

What is the management of croup?

Answer 10

Single dose of oral dexamethasone PO (0.15mg/kg) to all children regardless of severity or Budesonide neb 2mg

(Prednisolone alternative if dexamethasone not available)

Question 11

What is the emergency treatment of croup?

Answer 11

High flow oxygen

Nebulised adrenaline (5ml 1:5000)