Croup

Question 1

What is croup?

Answer 1

Croup is an acute infective respiratory disease affecting young children. It typically affects children aged 6 months to 2 years, however they can be older. It is an upper respiratory tract infection causing oedema in the larynx.

Question 2

Classic cause of croup?

Tx?

Answer 2

The classic cause of croup that you need to spot in your exams, is parainfluenza virus. It usually improves in less than 48 hours and responds well to treatment is steroids, particularly dexamethasone.

Question 3

Common causes for croup?

Answer 3

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 4

Presentation of croup?

Answer 4

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

Question 5

Management of croup?

Answer 5

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).

Stepwise options in severe croup to get control of symptoms:

Oral dexamethasone
Oxygen
Nebulised budesonide
Nebulised adrenalin
Intubation and ventilation