Croup

Question 1

What is croup?

Answer 1

Croup is an acute infective respiratory disease affecting young children. It is an upper respiratory tract infection causing oedema in the larynx.

Question 2

At what age does croup common affect?

Answer 2

It typically affects children aged 6 months to 2 years, however they can be older.

Question 3

What is the most common cause of croup?

Answer 3

Parainfluenza virus.

Question 4

What causes croup?

Answer 4

The common causes for croup are:

• Parainfluenza
• Influenza
• Adenovirus
• Respiratory Syncytial Virus (RSV)

Croup used to be caused by diphtheria. Croup caused by diphtheria leads to epiglottitis and has a high mortality. Vaccination mean that this is very rare in developed countries.

Question 5

What are the clinical features of croup?

Answer 5

• Increased work of breathing
• “Barking” cough, occurring in clusters of coughing episodes
• Hoarse voice
• Stridor
• Low grade fever

Question 6

Briefly describe the management of croup

Answer 6

Most cases can be managed at home with simple supportive treatment (fluids and rest). During attacks it can help to sit the child up and comfort them. Measures should be taken to avoid spreading infection, for example hand washing and staying off school.

Oral dexamethasone is very effective. This is usually a single dose of 150 mcg/kg, which can be repeated if required after 12 hours. Prednisolone is sometimes used as an alternative where dexamethasone in not available (e.g. by GPs).

Question 7

Briefly describe the stepwise management of croup

Answer 7

Stepwise options in severe croup to get control of symptoms:

• Oral dexamethasone
• Oxygen
• Nebulised budesonide
• Nebulised adrenalin
• Intubation and ventilation