Croup: Diagnosis and Management

• Published in: American family physician Vol. 97; no. 9; pp. 575 - 580
• Main Authors: Smith, Dustin K, McDermott, Andrew J, Sullivan, John F
• Format: Journal Article
• Language: English
• Published: United States American Academy of Family Physicians 01.05.2018
• Subjects: Abscesses; Acetaminophen - administration & dosage; Age; Airway management; Airway Management - methods; Airway Obstruction - etiology; Airway Obstruction - therapy; Antipyretics - administration & dosage; Asthma; Blood tests; Bronchoscopy; Child, Preschool; Croup - complications; Croup - physiopathology; Croup - therapy; Cyanosis; Dexamethasone - administration & dosage; Diagnostic tests; Dysphagia; Dyspnea; Endoscopy; Fever; Gastroesophageal reflux; Glucocorticoids - administration & dosage; Humans; Ibuprofen - administration & dosage; Illnesses; Infant; Intubation; Larynx; Medical diagnosis; Patients; Radiography; Respiratory diseases; Severity of Illness Index; Symptom Assessment - methods; Testing laboratories; Treatment Outcome; Tumors; Viral infections; Viruses
• ISSN: 0002-838X; 1532-0650

Croup is a common respiratory illness affecting 3% of children six months to three years of age. It accounts for 7% of hospitalizations annually for fever and/or acute respiratory illness in children younger than five years. Croup is a manifestation of upper airway obstruction resulting from swelling of the larynx, trachea, and bronchi, leading to inspiratory stridor and a barking cough. Many patients experience low-grade fevers, but fever is not necessary for diagnosis. Less commonly, stridor can be associated with acute epiglottitis, bacterial tracheitis, and foreign body airway obstruction. Laboratory studies are seldom needed for diagnosis of croup. Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended. Radiography and laryngoscopy should be reserved for patients in whom alternative diagnoses are suspected. Randomized controlled trials have demonstrated that a single dose of oral, intramuscular, or intravenous dexamethasone improves symptoms and reduces return visits and length of hospitalization in children with croup of any severity. In patients with moderate to severe croup, the addition of nebulized epinephrine improves symptoms and reduces length of hospitalization.