Highlights & Basics
- Croup is a common cause of acute respiratory distress in children.
- Acute onset of seal-like barky cough, in moderate to severe cases accompanied by stridor and sternal/intercostal indrawing.
- Careful history and physical exam sufficient for confirming clinical diagnosis and ruling out potentially serious differentials.
- Orally administered corticosteroids are the mainstay for all levels of severity, combined with nebulized epinephrine in moderate to severe croup to provide temporary relief of the symptoms of upper-airway obstruction.
Quick Reference
History & Exam
Key Factors
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Definition
Epidemiology
Etiology
Pathophysiology
Citations
Johnson D, Klassen T, Kellner J. Diagnosis and management of croup: Alberta Medical Association clinical practice guidelines. Alberta: Alberta Medical Association; 2015 [internet publication].[Full Text]
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50. Sendi K, Crysdale WS, Yoo J. Tracheitis: outcome of 1,700 cases presenting to the emergency department during two years. J Otolaryngol. 1992 Feb;21(1):20-4.[Abstract]
51. Tan AK, Manoukian JJ. Hospitalized croup (bacterial and viral): the role of rigid endoscopy. J Otolaryngol. 1992 Feb;21(1):48-53.[Abstract]
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54. Klassen TP, Feldman ME, Watters LK, et al. Nebulized budesonide for children with mild-to-moderate croup. N Engl J Med. 1994 Aug 4;331(5):285-9.[Abstract]
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63. Pedersen LV, Dahl M, Falk-Petersen HE, et al. Inhaled budesonide versus intramuscular dexamethasone in the treatment of pseudo-croup [in Danish]. Ugeskr Laeger. 1998 Apr 6;160(15):2253-6.[Abstract]
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72. Fanconi S, Burger R, Maurer H, et al. Transcutaneous carbon dioxide pressure for monitoring patients with severe croup. J Pediatr. 1990 Nov;117(5):701-5.[Abstract]
73. Corkey CW, Barker GA, Edmonds JF, et al. Radiographic tracheal diameter measurements in acute infectious croup: an objective scoring system. Crit Care Med. 1981 Aug;9(8):587-90.[Abstract]
74. Gardner HG, Powell KR, Roden VJ, et al. The evaluation of racemic epinephrine in the treatment of infectious croup. Pediatrics. 1973 Jul;52(1):52-5.[Abstract]
75. Waisman Y, Klein BL, Boenning DA, et al. Prospective randomized double-blind study comparing L-epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis (croup). Pediatrics. 1992 Feb;89(2):302-6.[Abstract]
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80. Kristjansson S, Berg-Kelly K, Winso E. Inhalation of racemic adrenaline in the treatment of mild and moderately severe croup. Clinical symptom score and oxygen saturation measurements for evaluation of treatment effects. Acta Paediatr. 1994 Nov;83(11):1156-60.[Abstract]
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82. Weber JE, Chudnofsky CR, Younger JG, et al. A randomized comparison of helium-oxygen mixture (Heliox) and racemic epinephrine for the treatment of moderate to severe croup. Pediatrics. 2001 Jun;107(6):E96.[Abstract][Full Text]
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85. Henry R. Moist air in the treatment of laryngotracheitis. Arch Dis Child. 1983 Aug;58(8):577.[Abstract][Full Text]
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90. Lavine E, Scolnik D. Lack of efficacy of humidification in the treatment of croup. Why do physicians persist in using an unproven modality? CJEM. 2001 Jul;3(3):209-12.[Abstract]
91. Greally P, Cheng K, Tanner MS, et al. Children with croup presenting with scalds. BMJ. 1990 Jul 14;301(6743):113.[Abstract][Full Text]
92. Terregino CA, Nairn SJ, Chansky ME, et al. The effect of Heliox on croup: a pilot study. Acad Emerg Med. 1998 Nov;5(11):1130-3.[Abstract]
93. Moraa I, Sturman N, McGuire TM, et al. Heliox for croup in children. Cochrane Database Syst Rev. 2018 Oct 29;10:CD006822.[Abstract][Full Text]
94. Gupta VK, Cheifetz IM. Heliox administration in the pediatric intensive care unit: an evidence-based review. Pediatr Crit Care Med. 2005 Mar;6(2):204-11.[Abstract]
95. Kemper KJ, Ritz RH, Benson MS, et al. Helium-oxygen mixture in the treatment of postextubation stridor in pediatric trauma patients. Crit Care Med. 1991 Mar;19(3):356-9.[Abstract]
96. Duncan PG. Efficacy of helium-oxygen mixtures in the management of severe viral and post-intubation croup. Can Anaesth Soc J. 1979 May;26(3):206-12.[Abstract]
97. Beckmann KR, Brueggemann WM Jr. Heliox treatment of severe croup. Am J Emerg Med. 2000 Oct;18(6):735-6.[Abstract]
98. McGee DL, Wald DA, Hinchliffe S. Helium-oxygen therapy in the emergency department. J Emerg Med. 1997 May-Jun;15(3):291-6.[Abstract]
99. DiCecco RJ, Rega PP. The application of heliox in the management of croup by an air ambulance service. Air Med J. 2004 Mar-Apr;23(2):33-5.[Abstract]
100. Johnson D, Williamson J. Croup: duration of symptoms and impact on family functioning. Pediatr Res. 2001;49:83A.
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