Last reviewed: March 2019
Last updated: June  2018

Summary

Definition

History and exam

Key diagnostic factors

  • symptoms increasing with agitation
  • distinctive seal-like barky cough
  • age 6 months to 6 years
Full details

Other diagnostic factors

  • male gender
  • 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
  • lethargy
  • asynchronous chest wall and abdominal movement
  • fatigue
  • signs of hypoxia (pallor or cyanosis)
  • signs of hypercarbia (decreased level of consciousness secondary to rising PaCO2)
Full details

Risk factors

  • age 6 months to 6 years
  • male gender
  • prior intubation
Full details

Diagnostic investigations

1st investigations to order

  • clinical exam
Full details

Investigations to consider

  • x-ray anteroposterior and lateral neck
Full details

Treatment algorithm

ACUTE

mild (no stridor at rest)

moderate (stridor at rest; no agitation or lethargy)

severe (stridor at rest with agitation or lethargy)

Contributors

Authors VIEW ALL

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 monograph.

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 monograph.

Peer reviewers VIEW ALL

Staff

Department of Pulmonary and Critical Care Medicine

Cleveland Clinic

Cleveland

OH

Disclosures

JC declares that he has no competing interests.

Assistant Professor

Pediatrics and Emergency Medicine

University of Ottawa

Ottawa

Canada

Disclosures

KF declares that he has no competing interests.

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.

Consultant Paediatrician

Children's Hospital and West Wing

John Radcliffe Hospital

Oxford

UK

Disclosures

JH declares that he has no competing interests.

Consultant Respiratory Paediatrician

Department of Respiratory & Sleep Medicine

Royal Hospital for Sick Children

Edinburgh

UK

Disclosures

SC declares that he has no competing interests.

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