Croup

Question 1

Clinical features

Answer 1

6 mths to 6 yrs, occasionally older, peak incidence 1–2 yrs

Loud inspiratory (increased if upset) harsh brassy cough

Viral cause—mostly parainfluenza 1, also RSV

Prodrome of URTI or coryza for 2 d

Fever variable—rarely above 39°C

Usually self-limiting

Question 2

Treatment

Grade 1 croup

Answer 2

• Barking cough
• stridor at rest without chest retraction
• hoarse voice

manage at home by keeping the child as calm as possible

avoid steaming measures but humid atmosphere helpful

consider oral steroids:

• if stridor and chest wall retraction develope
• e.g. prednisolone oral liquid; 0.15–0.3 mg/kg/dose

Question 3

Treatment

Grade 2 croup

Answer 3

• Inspiratory stridor at rest
• with sternal and chest wall retraction

admit to hospital (e.g. emergency department)

cool humidified air

oral steroids:

• dexamethasone 0.15–0.3 mg/kg or
• prednisolone (tablets or oral solution) 1 mg/kg (2–3 doses) and/or
• for children ≥ 2, budesonide 100 mcg × 20 puffs or 2 mg nebulised

nebulised adrenaline—if poor response to steroids

observe for at least 4 hrs; discharge when stridor-free at rest

Question 4

Treatment

Grade 3, severe croup

Answer 4

• marked respiratory distress
• with use of accessory muscles
• pt restless and agitated
• pallor
• cyanosis
• tachycardia
• exhaustion, i.e. impending airway obstruction

nurse in intensive care

oxygen

adrenaline is first-line therapy:

• nebulised adrenaline 1:1000 solution 0.5 mL/kg/dose (to max. 5 mL)
• beware possible rebound effect after 2–3 hrs—child must be observed
• can use 4–5 ampoules of 1:1000 solution in a nebuliser run with O2 8 L/min.
• repeat dose if no response in 10 mins.

dexamethasone 0.2 mg/kg IV or 0.6 mg/kg IM followed by oral steroids

have facilities for artificial airway

may need endotracheal intubation for 48 hrs

There is no place for cough medicine or antibiotics.

Question 5

Indications for steroids in croup

Answer 5

stridor

respiratory distress

age <2 yrs