Croup

Question 1

Definition

Answer 1

Croup, also known as laryngotracheobronchitis, is an infection of the upper airway. This causes inflammation which results in the upper airway becoming obstructed.

Question 2

Epidemiology

Answer 2

Typically affects children aged 6 months old to 6 years old. It is most common in children aged under 3 years old.
Majority of cases are in autumn and winter
Very common - affecting 1 in 6 children at least once

Question 3

Epidemiology

Answer 3

Typically affects children aged 6 months old to 6 years old. It is most common in children aged under 3 years old.
Majority of cases are in autumn and winter
Very common - affecting 1 in 6 children at least once

Question 4

Causes

Answer 4

Parainfluenza virus is the primary cause accounting for the vast majority of cases

Other viruses commonly infecting the upper respiratory tract can also cause croup e.g., adenovirus, influenza and RSV

Bacteria can also cause croup, and these cases are a lot more severe (Staphylococcus aureus (S. aureus))

Question 5

Presentation

Answer 5

Classically presents with a barking, seal-like cough.

Stridor may also be present - this can worsen if the child is upset

Fevers

Signs of increased work of breathing

Question 6

Management

Answer 6

Most cases are mild and dealt with in primary care with a single dose of dexamethasone

More severe cases may require hospital admission for observation, oxygen and nebulosed budesonide if the child won’t tolerate PO steroid

Where are there significant concerns about the airway, nebulised adrenaline may also be used

It is vital not to upset children with croup as their crying can worsen their upper airway obstruction