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Last updated: December 2023
Common viral respiratory infection with peak incidence amongst children between 6 months and 3 years.
Clinical features
- Typical barking cough, hoarse voice or cry.
- Inspiratory stridor (abnormal high pitched sound on inspiration):
- Croup is considered mild 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 intercostal, subcostal or sternal retractions, treat symptomatically: ensure adequate hydration, seek medical attention if symptoms worsen (e.g. respiratory difficulty, noisy breathing, inability to tolerate oral fluids).
- If stridor is only present with agitation (mild croup)
[1]
Citation
1.
Pocket book of primary health care for children and adolescents: guidelines for health promotion, disease prevention and management from the newborn period to adolescence. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NCSA 3.0 IGO.
https://www.who.int/europe/publications/i/item/9789289057622 :- Assure adequate hydration.
- Corticosteroids:
- dexamethasone a Citation a. Administer orally if possible in order to avoid causing agitation in the child as this may worsen symptoms. PO: 0.15 to 0.6 mg/kg (max. 16 mg) single dose
- or, if not available, prednisolone PO: 1 mg/kg single dose
- Keep the child under observation at least 30 minutes after oral corticosteroid. Consider hospitalisation or longer observation (> 4 hours) if the child is less than 6 months old, or is dehydrated, or lives far from health facility.
- If danger signs are present (stridor at rest, respiratory distress, hypoxia) or the child is unable to drink, admit to hospital
[1]
Citation
1.
Pocket book of primary health care for children and adolescents: guidelines for health promotion, disease prevention and management from the newborn period to adolescence. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NCSA 3.0 IGO.
https://www.who.int/europe/publications/i/item/9789289057622 :- Administer oxygen continuously if respiratory distress or SpO2 < 92%: maintain SpO2 between 94 and 98% (or if SpO2 cannot be determined, at least 5 litres/minute).
- Insert a peripheral IV line and provide IV hydration.
- Epinephrine (adrenaline) via nebulizer: 0.5 mg/kg (max. 5 mg) to be repeated every 20 minutes if danger signs persist (see table below).
Monitor heart rate during nebulization (if heart rate greater than 200, stop the nebulization).
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 (1 mg/ml, 1 ml ampoule) |
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 |
– |
– |
– |
Epinephrine is intended exclusively for nebulized administration and should not be given IV or IM in croup.
- Corticosteroids:
Weight |
6-8 kg |
9-11 kg |
12-14 kg |
15-17 kg |
---|---|---|---|---|
Dose in mg |
4 mg |
6 mg |
8 mg |
10 mg |
Dose in 2 mg tablet | 2 tab | 3 tab | 4 tab | 5 tab |
Dose in ml (4 mg/ml, 1 ml ampoule) |
1 ml |
1.5 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 arouse, does not smile, disconjugate or anxious gaze, pallor or cyanosis, general hypotonia. with croup who does not improve with the above treatment.
- If the patient has a complete airway obstruction, intubation if possible or emergency tracheotomy.
Footnotes
- (a)Add sufficient NaCl 0.9% to obtain a total volume of 4 to 4.5 ml in the nebulizing chamber.
References
- 1.
Pocket book of primary health care for children and adolescents: guidelines for health promotion, disease prevention and management from the newborn period to adolescence. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NCSA 3.0 IGO.
https://www.who.int/europe/publications/i/item/9789289057622