Viral infection in children aged 3 months to 4 years.
– 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.
– 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.
• dexamethasone1 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).
Dose in mg
Dose in ml
* Add sufficient NaCl 0.9% to obtain a total volume of 4 to 4.5 ml in the nebulizing chamber.
Epinephrine is intended exclusively for nebulized administration and should not be given IV or IM in croup.
• dexamethasone 1 (4 mg/ml, 1 ml ampoule) IM or IV: 0.6 mg/kg single dose
Dose in mg
Dose in ml
Suspect bacterial tracheitis in a critically ill appearing child2 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.
|1||Administer orally if possible in order to avoid causing agitation in the child as this may worsen symptoms. [ a b ]|
|2||Critically ill appearing child: weak grunting or crying, drowsiness, difficult to arrouse, does not smile, unconjugate or anxious gaze, pallor or cyanosis, general hypotonia.|