Viral infection in children aged 3 months to 4 years.
Clinical features
- Typical barking cough, hoarse voice or cry.
- Inspiratory stridor (abnormal high pitched sound on inspiration):
- Croup is considered mild or moderate if the stridor only occurs with agitation;
- Croup is considered severe if there is stridor at rest, especially when it is accompanied by respiratory distress.
- Wheezing may also be present if the bronchi are involved.
Treatment
- In the absence of inspiratory stridor or retractions, treat symptomatically: ensure adequate hydration, seek medical attention if symptoms worsen (e.g. respiratory difficulty, noisy breathing and inability to tolerate oral fluids).
- If stridor is only present with agitation (moderate croup):
- Hospitalize for treatment and observation (risk of worsening).
- Assure adequate hydration.
- dexamethasone a Citation a. Administer orally if possible in order to avoid causing agitation in the child as this may worsen symptoms. PO (use IV preparation flavoured with sugar water, 10% or 50% glucose or juice) or IM if child is vomiting: 0.6 mg/kg single dose (see table).
- If danger signs are present (stridor at rest, respiratory distress), admit in intensive care:
- Oxygen continuously: at least 5 litres/minute or to maintain the SpO2 between 94 and 98%.
- Insert a peripheral IV line and provide IV hydration.
- epinephrine (adrenaline) via nebulizer (1 mg/ml, 1 ml ampoule): 0.5 mg/kg (max. 5 mg) to be repeated every 20 minutes if danger signs persist.
Monitor heart rate during nebulization (if heart rate greater than 200, stop the nebulization).
|
Age |
3 months |
4-6 months |
7-9 months |
10-11 months |
1-4 years |
|---|---|---|---|---|---|
|
Weight |
6 kg |
7 kg |
8 kg |
9 kg |
10-17 kg |
|
Dose in mg |
3 mg |
3.5 mg |
4 mg |
4.5 mg |
5 mg |
|
Dose in ml |
3 ml |
3.5 ml |
4 ml |
4.5 ml |
5 ml |
|
NaCl 0.9% (a) Citation a. Add sufficient NaCl 0.9% to obtain a total volume of 4 to 4.5 ml in the nebulizing chamber. |
1 ml |
1 ml |
– |
– |
– |
- dexamethasone a Citation a. Administer orally if possible in order to avoid causing agitation in the child as this may worsen symptoms. (4 mg/ml, 1 ml ampoule) IM or IV: 0.6 mg/kg single dose
|
Age |
3-11 months |
1-2 years |
3-4 years |
|---|---|---|---|
|
Weight |
6-9 kg |
10-13 kg |
14-17 kg |
|
Dose in mg |
4 mg |
8 mg |
10 mg |
|
Dose in ml |
1 ml |
2 ml |
2.5 ml |
Suspect bacterial tracheitis in a critically ill appearing child b Citation b. Critically ill appearing child: weak grunting or crying, drowsiness, difficult to arrouse, does not smile, unconjugate or anxious gaze, pallor or cyanosis, general hypotonia. with croup who does not improve with the above treatment.
- If wheezing is present:
salbutamol aerosol (using a spacer): 2 to 3 puffs every 20 to 30 minutes as needed
- If the patient has a complete airway obstruction, intubation if possible or emergency tracheotomy.
- (a)Add sufficient NaCl 0.9% to obtain a total volume of 4 to 4.5 ml in the nebulizing chamber.