Common cause of acute respiratory distress in children.
Acute onset of seal-like barky cough, in moderate to severe cases accompanied by stridor and sternal/intercostal indrawing.
Careful history and physical exam sufficient for confirming clinical diagnosis and ruling out potentially serious differentials.
Orally administered corticosteroids are the mainstay for all levels of severity, combined with nebulized epinephrine in moderate to severe croup to provide temporary relief of the symptoms of upper-airway obstruction.
Croup, also known as laryngotracheobronchitis, is a common respiratory disease of childhood, characterized by the sudden onset of a seal-like barky cough, often accompanied by stridor, voice hoarseness, and respiratory distress. The symptoms are a result of upper-airway obstruction due to generalized inflammation of the airways, as a result of viral infection (typically parainfluenza virus types 1 or 3).
History and exam
- male sex
- peak season late autumn (North America)
- prodromal symptoms
- abrupt onset of symptoms
- symptoms worse at night
- hoarse voice
- respiratory distress (sternal/intercostal indrawing, stridor)
- persistent agitation
- asynchronous chest wall and abdominal movement
- signs of hypoxia (pallor or cyanosis)
- signs of hypercapnia (decreased level of consciousness secondary to rising PaCO₂)
Candice Bjornson, MSc, MD, FRCPC
University of Calgary
CB declares that she has no competing interests. CB is the author of several references in this topic.
David Johnson, MD
Department of Pediatrics and Physiology and Pharmacology
University of Calgary
DJ declares that he has no competing interests. DJ is the author of several references in this topic.
Jeffrey Chapman, MD
Department of Pulmonary and Critical Care Medicine
JC declares that he has no competing interests.
Ken Farion, MD
Pediatrics and Emergency Medicine
University of Ottawa
KF declares that he has no competing interests.
Doreen Matsui, MD, FRCPC
Departments of Paediatrics and Medicine
Children's Hospital of Western Ontario
DM declares that she has no competing interests.
Jeremy Hull, MBBS
Children's Hospital and West Wing
John Radcliffe Hospital
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
SC declares that he has no competing interests.
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