Summary
Definition
History and exam
Key diagnostic factors
- symptoms increasing with agitation
- distinctive seal-like barky cough
- age 6 months to 6 years
Other diagnostic factors
- male sex
- peak season late autumn
- prodromal symptoms
- abrupt onset of symptoms
- symptoms worse at night
- hoarse voice
- respiratory distress (sternal/intercostal indrawing, stridor)
- persistent agitation
- lethargy
- asynchronous chest wall and abdominal movement
- fatigue
- signs of hypoxia (pallor or cyanosis)
- signs of hypercapnia (decreased level of consciousness secondary to rising PaCO₂)
Risk factors
- age 6 months to 6 years
- male sex
- prior intubation
Diagnostic investigations
1st investigations to order
- clinical exam
Investigations to consider
- x-ray anteroposterior and lateral neck
Treatment algorithm
mild (no stridor at rest)
moderate (stridor at rest; no agitation or lethargy)
severe (stridor at rest with agitation or lethargy)
Contributors
Authors
Candice Bjornson, MSc, MD, FRCPC
Associate Professor
University of Calgary
Calgary
Canada
Disclosures
CB declares that she has no competing interests. CB is the author of several references in this topic.
David Johnson, MD
Professor
Department of Pediatrics and Physiology and Pharmacology
University of Calgary
Calgary
Canada
Disclosures
DJ declares that he has no competing interests. DJ is the author of several references in this topic.
Peer reviewers
Ken Farion, MD
Assistant Professor
Pediatrics and Emergency Medicine
University of Ottawa
Ottawa
Canada
Disclosures
KF declares that he has no competing interests.
Doreen Matsui, MD, FRCPC
Associate Professor
Departments of Paediatrics and Medicine
Children's Hospital of Western Ontario
London
Ontario
Canada
Disclosures
DM declares that she has no competing interests.
Jeremy Hull, MBBS
Consultant Paediatrician
Children's Hospital and West Wing
John Radcliffe Hospital
Oxford
UK
Disclosures
JH declares that he has no competing interests.
Steve Cunningham, MBBS, PhD
Consultant Respiratory Paediatrician
Department of Respiratory & Sleep Medicine
Royal Hospital for Sick Children
Edinburgh
UK
Disclosures
SC declares that he has no competing interests.
Donna J. Lee, MD
Pediatric Pulmonology,
Joseph M. Sanzari Children's Hospital,
Hackensack Meridian Health
Hackensack
NJ
Disclosures
DL declares that he has no competing interests.
Deepak Mehta, MD, FRCS ( Oto)
Professor of Otolaryngology,
Director Pediatric Aerodigestive Center,
Baylor College of Medicine,
Texas Children’s Hospital,
Houston
TX
Disclosures
DM declares that he has no competing interests.
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