Croup | Notion

Croup is a form of upper respiratory tract infection seen in infants and toddlers. It is characterised by stridor which is caused by a combination of laryngeal oedema and secretions. Parainfluenza viruses account for the majority of cases.

Epidemiology

peak incidence at 6 months - 3 years
more common in autumn

Features

cough
- barking, seal-like
- worse at night
stridor
- remember, the throat should be not examined due to the risk of precipitating airway obstruction
fever
coryzal symptoms
increased work of breathing e.g. retraction

Severity grading:

Mild	Moderate	Severe
• Occasional barking cough
• No audible stridor at rest
• No or mild suprasternal and/or intercostal recession
• The child is happy and is prepared to eat, drink, and play	• Frequent barking cough
• Easily audible stridor at rest
• Suprasternal and sternal wall retraction at rest
• No or little distress or agitation
• The child can be placated and is interested in its surroundings	• Frequent barking cough
• Prominent inspiratory (and occasionally, expiratory) stridor at rest
• Marked sternal wall retractions
• Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)
• Tachycardia occurs with more severe obstructive symptoms and hypoxaemia

NICE suggest admitting any child with:

moderate or severe croup
< 3 months of age
known upper airway abnormalities (e.g. Laryngomalacia, Down's syndrome)
uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)

Investigations

the vast majority of children are diagnosed clinically