1,2 It is a common cause of upper airway obstruction in young children. J. Med. Croup usually gets better in three to four days. Prednisolone versus dexamethasone in croup: a randomised equivalence trial. 371(9609) 329-339. The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial. Correlating the clinical course of recurrent croup with endoscopic findings: a retrospective observational study. Advertising revenue supports our not-for-profit mission. Cochrane Database Syst. Treatment is typically based on the severity of symptoms. Glucocorticoids for croup. EMA 19, 51–58. All rights reserved. Merck Manual Professional Version. Croup can get worse quickly. Rev. EMA 21, 309–314. BMJ Clin. 62, 23–28. Pediatr. https://doi.org/10.1097/PEC.0b013e31821314b0, Russell, K.F., Liang, Y., O’Gorman, K., Johnson, D.W., Klassen, T.P., 2011. https://doi.org/10.1111/j.1440-1754.2010.01892.x, Tyler, A., McLeod, L., Beaty, B., Juarez-Colunga, E., Birkholz, M., Hyman, D., Kempe, A., Todd, J., Dempsey, A.F., 2017. Objective endoscopic findings in patients with recurrent croup: 10-year retrospective analysis. https://doi.org/10.1016/j.ajem.2015.12.082, Hiebert, J.C., Zhao, Y.D., Willis, E.B., 2016. Current pharmacological options in the treatment of croup. The main goals in the history and physical examination of infants presenting with wheeze or other lower respiratory tract symptoms, particularly in the winter season, is to differentiate infants with probable viral bronchiolitis from those with other disorders. A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup ; Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial ; Oral dexamethasone in the treatment of coup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg ; Related Links – 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. Ann. Immediately go to the hospital or call 999 if your child: is struggling to breathe; has grey or blue skin or lips Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. 2014;2014:0321. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178284/. Fam. Croup. Treatment with dexamethasone results in faster resolution of symptoms and decreased return to medical care.21 Corticosteroids are thought to work by decreasing laryngeal mucosal edema through their anti-inflammatory effects. Early administration of oral dexamethasone is the mainstay of treatment, even in mild croup. Elk Grove Village, Ill.: American Academy of Pediatrics; 2018. https://redbook.solutions.aap.org. Aust. However, if your child's symptoms are severe or aren't responding to home treatment, you should call your doctor. World Fed. Kline-Krammes, S., Reed, C., Giuliano, J.S., Schwartz, H.P., Forbes, M., Pope, J., Besunder, J., Gothard, M.D., Russell, K., Bigham, M.T., 2012. 26 Croup is most prevalent in the late fall to early winter months, but can occur year-round. Nebulized epinephrine for croup in children. 90, 86–90. Most children with mild croup symptoms can be successfully treated a… Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Crying makes breathing more difficult. Has your child's cough become progressively worse? Soft stridor in the presence of worsening clinical picture may be a sign of imminent airway obstruction, ** It is not necessary to measure oxygen saturations in children with mild to moderate croup, No investigations are needed in croup (including nasopharyngeal aspirate, X-rays and blood tests) and they may cause distress to the child and worsening of symptoms, *Consider nebulised budesonide 2mg if oral corticosteroids not tolerated, For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services, Stridor free at rest  If your child is having problems breathing, seek urgent medical assistance. Seasonality patterns in croup presentations to emergency departments in Alberta, Canada: a time series analysis. Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study. Bjornson CL, et al. Provide humidified or cool air. (Phila.) "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Intensive Care 44, 245–250. The Lancet 371, 329–339. Rev. Otorhinolaryngol. Paediatr. Australas. (Phila.) Has your child had a fever or difficulty swallowing? Physician 37, 14–20. Klassen, T.P., Craig, W.R., Moher, D., Osmond, M.H., Pasterkamp, H., Sutcliffe, T., Watters, L.K., Rowe, P.C., 1998. The symptoms of croup are usually mild, but they can change and become worse quickly. The majority of children with croup can be treated at home. Listen to your child's chest with a stethoscope. J. Soc. https://doi.org/10.1136/adc.2005.089516, Tibballs, J., Watson, T., 2011. Acute upper airway obstruction  Urgent care or emergency department treatment of croup depends on the patient's degree of respiratory distress. Johnson, D.W., 2009. https://doi.org/10.1016/S0140-6736(08)60170-1, Bjornson, C.L., Klassen, T.P., Williamson, J., Brant, R., Mitton, C., Plint, A., Bulloch, B., Evered, L., Johnson, D.W., 2004. Croup. Rhinol. Emerg. It's usually mild, but it's important to call NHS 111 if you suspect your child has croup. 79, 2343–2347. Glucocorticoids for croup in children. This may prevent representation with ongoing stridor. Nebulised L-epinephrine and steroid combination in the treatment of moderate to severe croup. Pediatr. 2013;185:1317. 91, 580–583. https://www.cdc.gov/parainfluenza/about/index.html. Northern(California(Pediatric(Hospital(Medicine(Consortium.(Originated(1/2016.(Updated:(06/2016,(10/2017. Emerg. https://doi.org/10.1002/14651858.CD001955.pub3, Scolnik, D., Coates, A.L., Stephens, D., Da Silva, Z., Lavine, E., Schuh, S., 2006. For instance, does it get worse at night? 71, 473–477. Most clinicians characterize respiratory distress as mild, moderate, severe or impending respiratory failure. Med. In the meantime, keep your child comfortable with a few simple measures: Your child's cough may improve during the day, but don't be surprised if it returns at night. https://doi.org/10.1016/j.amj.2011.08.004, Knapp, J.F., Hall, M., Sharma, V., 2010. • Unnecessary interventions or procedures should be avoided to prevent further distress and the potential worsening of symptoms. Check if your child has croup. Type of oral cortiosteroid in mild to moderate croup. Croup. BET 4. Rev. Emerg. 2. Emerg. Accessed Jan. 7, 2019. He or she will: Sometimes X-rays or other tests are used to rule out other possible illnesses. J. EMJ 20, 264. Accessed Jan. 7, 2019. Children presenting with severe distress or impending respiratory failure should be r… Bacterial tracheitis. J. EMJ 31, 160–162. https://doi.org/10.1542/hpeds.2013-0066, Ortiz-Alvarez, O., 2017. Emerg. https://doi.org/10.1017/S0022215113000418, Rosychuk, R.J., Klassen, T.P., Metes, D., Voaklander, D.C., Senthilselvan, A., Rowe, B.H., 2010. Consider alternative diagnosis and causes of upper airway obstruction, Keep children with carers to reduce distress, Children will adopt a position of comfort that minimises airway obstruction, do not change this, Treat mild croup with steroids alone. https://www.cdc.gov/features/hibdisease/. Accessed Jan. 7, 2019. Are your child's vaccinations up to date? Emerg. A type of steroid (glucocorticoid) may be given to reduce inflammation in the airway. Smith DK, et al. Care Med. Prehospital dexamethasone administration in children with croup: A medical record review. Moder… In most cases of croup, your child won't need to see a doctor. Benefits will typically be felt within a few hours. Variation in Inpatient Croup Management and Outcomes. Baugh JM (expert opinion). https://doi.org/10.1016/j.amjoto.2006.11.013, Leung, K., Newth, C.J.L., Hotz, J.C., O’Brien, K.C., Fink, J.B., Coates, A.L., 2016. 57, 706–710. Int. Management of croup in the emergency department: The role of multidose nebulized epinephrine. dexamethasone) by mouth may be of benefit. Pediatr. Int. 25, 183–189. Emerg. N. Engl. 34, 599–601. Australas. 2018;10:141. Croup (acute laryngotracheobronchitis) is a clinical syndrome characterised by barking cough, inspiratory stridor and hoarseness of voice with or without respiratory distress. Evid. Emerg. Medicine (Baltimore) 96. https://doi.org/10.1097/MD.0000000000007667. Med. Croup; Croup - management in the intensive care setting; Cultural Care for the palliative patient; Cytogenic and Molecular Genetic Studies in the Neonatal Period; Cytokines in the treatment of child cancer; D Death of an infant in NICU; Delivery - attendance at high risk delivery by specialist neonatologist Merck Manual Professional Version. 30, 70–75. Pharmacol. See also. Canadian Medical Association Journal. The severity of the child’s respiratory distress on presentation to the ED should guide management (Table 2). Emerg. If so, how rapidly? Pediatr. Australas. Med. 52, 1329–1334. Has your child recently been exposed to other sick children? https://doi.org/10.1177/000348940811700610, Hodnett, B.L., Simons, J.P., Riera, K.M., Mehta, D.K., Maguire, R.C., 2015. Centers for Disease Control and Prevention. Fam. Kimberlin DW, et al. Care Soc. https://doi.org/10.1016/j.ijporl.2003.11.017. Cochrane Database Syst. https://doi.org/10.1016/j.ijporl.2015.10.039. Budesonide offers no advantage when added to oral dexamethasone in the treatment of croup. 31, 131–137. Recurrent croup presentation, diagnosis, and management. Care Med. 3. Clin. Croup - assessment and management. of return for medical care with ongoing croup, and further treatment with steroids in the week following first presentation. Comparison of the Effect of Cold Drink and Dexamethasone, and their Combined Effect on Children with Croup. Occasionally children with croup need to be treated in the hospital. Intensive Crit. Heliox administration in the pediatric intensive care unit: an evidence-based review. This type of croup causes spasms that occur during the night and early morning. Accessed Jan. 7, 2019. Cherry, J.D., 2008. Croup. Preparing and anticipating questions will help you make the most of your time with the doctor. https://doi.org/10.1002/ppul.21162, Rosychuk, R.J., Klassen, T.P., Voaklander, D.C., Senthilselvan, A., Rowe, B.H., 2011. Air Med. There were no significant differences between the three treatment groups. JAMA 279, 1629–1632. Lancet. J. Pediatr. Cochrane Database of Systematic Reviews. adjunct treatment for patients in continued respiratory distress • Budesonide 2mg Inhaled , once Advanced/Surgical Airway Preparations should be made for a difficult airway in a patient with croup that requires intubation. Inpatient hospitalizations for croup. https://doi.org/10.1056/NEJMcp072022, Chub-Uppakarn, S., Sangsupawanich, P., 2007. CD006619. Spasmodic croup. Drug Investig. Use caution when giving cough and cold products to kids. Johnson DW. 351, 1306–1313. Hold your child, sing lullabies or read quiet stories. In: Red Book Online. Croup: Diagnosis and management. This content does not have an Arabic version. Med. Acute onset of seal-like barky cough in moderate to severe cases accompanied by stridor and sternal/intercostal indrawing. Rev. Anaesth. Assessment and management of viral croup in children: Viral croup. Common cause of acute respiratory distress in children. Oral dexamethasone in the treatment of croup: 0.15mg/kg versus 0.3mg/kg versus 0.6mg/kg. Am. Dose of dexamethasone in croup. upset the child further. It is characterized by the sudden onset of a seal-like barking cough usually accompanied by stridor (predominantly inspiratory), hoarse voice, and respiratory distress due to upper-airway obstruction. Pediatr. 127, 494–500. https://doi.org/10.1007/s00134-007-0855-0, Atkinson, P.R.T., Boyle, A.A., Lennon, R.S.P., 2014. Rev. Pediatric Emergency Care. Pediatrics 139. https://doi.org/10.1542/peds.2016-3582, Wright, M., Bush, A., 2016. Croup often runs its course within three to five days. 82, 629–636. Failure of Outpatient Management With Different Observation Times After Racemic Epinephrine for Croup. Geelhoed G.C, Macdonald, W.B.,1995. Int. Dis. 3,4 Illness is typically mild and self-limiting but can be severe and rarely, life-threatening. Croup in children. Acute upper airway obstruction Inhaled foreign body. J. Pediatr. Gupta, V.K., Cheifetz, I.M., 2005. Comfort or distract your child — cuddle, read a book or play a quiet game. Mild croup is largely self-limiting, but treatment with a single dose of a corticosteroid (e.g. Mayo Clinic facts about coronavirus disease 2019 (COVID-19), Our COVID-19 patient and visitor guidelines, plus trusted health information, Mayo Clinic Health System patient vaccination updates, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, FREE book offer — Mayo Clinic Health Letter, Time running out - 40% off Online Mayo Clinic Diet ends soon. 2008. Acute Respiratory Distress in Children: Croup and Acute Asthma. 17, e177-181. https://doi.org/10.1136/emj.2009.072090. Physician 39, 269. The information on management of a child with croup is largely based on expert opinion in the BMJ Best Practice guideline Croup [BMJ Best practice, 2017] and what CKS considers to be appropriate best clinical practice.. Hospital admission. Benchmarks for the emergency department care of children with asthma, bronchiolitis, and croup. Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized, double-blinded clinical trial. Does your child have any other medical conditions? Intensive care management of children intubated for croup: a retrospective analysis. Fundam. Intensive Care Med. https://doi.org/10.1177/0009922813504823, Gates, A., Gates, M., Vandermeer, B., Johnson, C., Hartling, L., Johnson, D.W., Klassen, T.P., 2018. Crit. N. Engl. https://www.cdc.gov/diphtheria/materials.html. https://doi.org/10.1002/14651858.CD001955.pub4. Off. 4. Care Med. Accessed Jan. 7, 2019. J. Soc. Mayo Clinic, Rochester, Minn. Jan. 23, 2019. Protect your child against Hib disease. Emerg. Pediatr. EMA 24, 79–85. J. Soc. Note: Swabbing for COVID-19 should not be performed until deemed safe to do so by a senior clinician Published guidelines for the diagnosis and treatment of croup advise using steroids as the mainstay treatment for all children who present to emergency department (ED) with croup symptoms. See, Supplemental oxygen is not usually required. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. The effectiveness of local corticosteroids therapy in the management of mild to moderate viral croup. Schedule your appointment now for safe in-person care. About human parainfluenza viruses (HPIVs). This Canadian guideline aims to help clinicians understand and practice appropriate diagnosis, differential diagnosis, treatment and management of croup. Croup (child). Dobrovoljac, M., Geelhoed, G.C., 2012. Centers for Disease Control and Prevention. It Diphtheria and the vaccine (shot) to prevent it. Acad. This site complies with the HONcode standard for trustworthy health information: verify here. Health Info  Severe croupis treated as above with high flow oxygen and nebulised adrenaline. Consider early transfer and involvement of senior staff if concerns regarding worsening upper airway obstruction, For severe and life-threatening croup, use nebulised adrenaline, Less severe cases can be managed with corticosteroids alone, Croup is inflammation of the upper airway, larynx and trachea, usually triggered by a virus, Occurs generally between the ages of 6 months and 6 years, Alternative diagnoses include: bacterial tracheitis, inhaled foreign body, anaphylaxis. 28, 401–407. Child Health 22, 166–169. Croup, 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way, Hypoxia is a late sign which indicates life-threatening croup, No stridor, or only when active or upset. Croup is a self‐limited respiratory illness of childhood caused by a number of different viruses. Child Health 20, 19–20. Reassess the appropriateness of Care Guidelines as condition changes. Adrenaline can be repeated 10 minutely as required All severe and life threatening croup should be discussed with a Senior Doctor +/- Paediatric Critical Care Unit and the child admitted under the General Paediatric Team. 68, 453–456. https://doi.org/10.1056/NEJMoa033534, Cetinkaya, F., Tüfekçi, B.S., Kutluk, G., 2004. Otorhinolaryngol. Your child likely will need to be observed in the emergency room for several hours before going home to determine if a second dose is needed. Although there's no evidence of benefit from these practices, many parents believe that humid air or cool air helps a child's breathing. Clinical scores used in research studies have not been shown to improve clinical care . Therefore if using prednisolone as treatment for croup a second dose is recommended. Minimise distress to the child, as this can worsen upper airway obstruction. Croup (laryngotracheobronchitis) is a very common cause of upper airway obstruction in children and has an annual incidence in Alberta of 6 % in children under six years of age. Barking cough with no other symptoms does not always require steroids, Moderate croup is usually managed with steroids alone, consider adrenaline if persistent or worsening symptoms, Severe croup requires nebulised adrenaline and steroids. Have you noticed a pattern to your child's cough? Gelbart, B., Parsons, S., Sarpal, A., Ninova, P., Butt, W., 2016. Dexamethasone, given orally as a single dose at 0.6 mg/kg, is highly efficacious in treating croup … © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). Am. https://doi.org/10.1111/j.1742-6723.2006.00919.x, Garbutt, J.M., Conlon, B., Sterkel, R., Baty, J., Schechtman, K.B., Mandrell, K., Leege, E., Gentry, S., Stunk, R.C., 2013. https://www.merckmanuals.com/professional/pediatrics/respiratory-disorders-in-young-children/croup. Mayo Clinic does not endorse companies or products. Otorhinolaryngol. Parainfluenza viral infections. Acute management of croup in the emergency department. Corticosteroids should be used in patients with croup of any severity. Donaldson, D., Poleski, D., Knipple, E., Filips, K., Reetz, L., Pascual, R.G., Jackson, R.E., 2003.
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