This work was prepared as part of our official duties. There is no statistically significant difference between corticosteroids and epinephrine, although patients treated with corticosteroids require less epinephrine.22 Another review showed that corticosteroids are safe to use in children with acute respiratory conditions.23, Dexamethasone is the preferred corticosteroid because it is given as a single dose and can be given orally, intramuscularly, or intravenously. Even so, early identification and aggressive treatment are critical in this subgroup of very sick children in order to maintain this low mortality rate. J Emerg Med. 1978;132(5):484–487. 11 For severe croup, the APLS advocates racemic or L-epinephrine, followed by observation for 3 or 4 hours and hospital admission in the event of inadequate response or recurrence of severe distress. The authors explain how to recognize viral croup, review the latest studies on when to use nebulized or systemic steroids, … Differentiating croup from other acute illnesses can be challenging. Among the noninfectious etiologies of this syndrome are foreign body Parainfluenza virus infection of young children: estimates of the population-based burden of hospitalization. Russell KF, Johnson DW. Klassen TP, Watters LK, Feldman ME, et al. 2. 15. • Petrocheilou A, et al. This syndrome, recognized and respected by physicians for centuries, inherited its name, croup, from the Anglo-Saxon word kropan, 1 or from an old Scottish word roup, which meant to cry out in a hoarse voice. Rales are generally not present in croup, so this finding should prompt further evaluation.12,13,16, More than 99% of children with abrupt stridor have croup, but the differential diagnosis is broad6  (Table 12,5,6,14,16–18). Croup. Atypical croup: association with airway lesions, atopy, and esophagitis. Pediatrics. • Richards AM. Although the optimal dose is unclear, 0.6 mg per kg is the most commonly used.13,24 Dexamethasone is superior to budesonide for improving symptoms scores, but there is no significant difference in return visits or readmissions. After completing this article, readers should be able to: Clarify the definition and terminology of viral croup. Croup is a condition that causes a swelling of the voice box (larynx) and windpipe (trachea). Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. 9(May 1, 2018) Corticosteroids should be administered to patients with croup of any severity. Budesonide offers no advantage when added to oral dexamethasone in the treatment of croup. A randomized trial of a single dose of oral dexamethasone for mild croup. an infectious agent. The effects of epinephrine wane after one to two hours, so patients should be monitored for at least two hours after administration before they are discharged.6,25 Although adverse effects of nebulized epinephrine are rare, patients receiving frequent treatments should be monitored for adverse cardiac effects. Although cyanosis is absent in most patients with croup, its presence suggests severe disease.12,13,16, The most common auscultatory finding is overt inspiratory stridor in the neck. Clinical Practice Guidelines are developed by multi-disciplinary subcommittees using an evidence-based approach, combining the best research available with expert consensus on best practice. Stroud RH , Friedman NR . A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Differentiate epiglottitis from viral croup. van Driel ML. The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: an overview of reviews. Pediatr Emerg Care 2005; 21:359. Feigin & Cherry's Textbook of Pediatric Infectious Diseases. 2016;30(1):70–75. such as laryngotracheobronchitis and laryngotracheobronchopneumonitis. This content is owned by the AAFP. Croup often starts, as many respiratory infections do, with a runny nose, fever, and a red, sore throat. episodes of croup and that have a history of intubation and age less than 36 months or who have prolonged severe disease requiring inpatient management. Faden H. Huang CT. Bjornson CL, J Emerg Med. Sabbagh A, Sterkel R, BMJ Clin Evid. Sidani M, Steeple sign: not specific for croup. Nebulized epinephrine for croup in children. Rowe BH, 2007;28(6):401–407. In patients with moderate to severe croup, the addition of nebulized epinephrine improves symptoms and reduces length of hospitalization. Kaditis AG, Warning signs are stridor at rest, drooling, or labored breathing. Cates CJ, Crying makes breathing more difficult. Cherry JD. varies in anatomic involvement and etiologic agents and includes responsible for causing disease further down the respiratory tract, Pediatrics. 2004;351(13):1306–1313. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 25. The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial. Iwane MK, 1998;73(11):1102–1106. 1978;132(5):485. Hiebert JC, Clarke MJ, 6. The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial. Woods CR, A community-based randomized trial of children with mild to moderate croup found no difference in symptom scores between a single dose of dexamethasone and three daily doses of prednisolone. In mild croup, a child may present with only a croupy cough and may just require parental guidance and reassurance, given alertness, baseline minimal respiratory distress, proper oxygenation, and stable fluid status. Kalampouka E, Croup is a common respiratory illness in children. All rights Reserved. Evidence-Based Guidelines At least two comprehensive evidence-based guidelines covering the diagnosis, man-agement, and prevention of acute bronchiolitis have been published in the past 18 months. Pediatrics 1996; 97:463. Compared with prednisolone, dexamethasone use in the emergency department or hospital may decrease rates of return visits or readmissions.22 However, a community-based randomized trial found no difference between single-dose dexamethasone and three daily doses of prednisolone for treatment of mild to moderate croup.24, Epinephrine is thought to improve symptoms in patients with croup through arteriole vasoconstriction in the upper airway mucosa, which eventually leads to decreased edema. JAMA. It is more common in boys than in girls (1.5:1 ratio). Kwong K, Holman RC, Taherahmadi H, Contact Kalampouka E, Croup (laryngitis, laryngotracheitis, spasmodic croup, and laryngotracheobronchitis). Williamson J, 3. Viral croup: diagnosis and a treatment algorithm. Comfort or distract your child — cuddle, read a book or play a quiet game. 2019;144(3). Knutson D, This clinical content conforms to AAFP criteria for continuing medical education (CME). Scolnik D, Thank you for your interest in spreading the word on American Academy of Pediatrics. 2004;69(3):535–540. Weinberg GA, / Journals 20. J Paediatr Child Health. Tibballs J, NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Coates AL, 2008; 358(4):384–391. Retractions and nasal flaring may indicate more severe cases. Clyde WA Jr, Liang Y, Although the terms “laryngotracheitis” and“ See the CME Quiz Questions. Collier AM, Copyright © 2020 American Academy of Family Physicians. laryngotracheobronchitis, and laryngotracheobronchopneumonitis. Johnson DW. Bjornson C, Liang Y, Klassen TP, Bacterial tracheitis, also known as membranous or bacterial croup, Provide humidified or cool air. Moraa I, Rebound stridor in children with croup after nebulised adrenaline: does it really exist? 2014;2014. 10. November 2014; 134 (5). Croup in children. aspiration, trauma (eg, due to intubation), and allergic reaction (eg, Huang CT. Am J Dis Child. Sign up for the free AFP email table of contents. 3,4 Illness is typically mild and self-limiting but can be severe and rarely, life-threatening. Johnson DW. Viral croup: diagnosis and a treatment algorithm. Am Fam Physician. the literature, they represent two different disease states. Persad R, Consider evaluation for GERD and initiation of anti-reflux medications in patients with prolonged or recurrent croup 3. et al. Am Fam Physician. Amisha Malhotra, MD* 2. common and most typical form of the viral croup syndrome is acute 19. Delineate the clinical signs and symptoms associated with viral croup. Bjornson CL, Sidani M, However, croup accounts for significant rates of ED visits and hospitalizations in Canada, with one population-based study in Alberta reporting that 3.2% to 5.1% of all ED visits in children <2 years of age were related to croup . 2. This article requires a subscription to view the full text. Murray J. Petrocheilou A, 1998;17(9):827–834. Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended. Although humidified air inhalation has been historically used for management of croup, a meta-analysis of three studies (N = 125) found no statistically significant effect on croup scores or hospital admission in patients with moderate croup.27 Treatment with specifically designed humidity droplets that deposit in the larynx is no better than controlled delivery of 40% humidity or humidity via blow-by administration.28, Heliox is a helium and oxygen mixture used for respiratory conditions that theoretically improves airflow resistance by decreasing gas density (helium is a low-density gas). , Holman RC, Clarke MJ, Anderson LJ gain access using your login for! Cuddle, read a book or play a quiet game membranous or bacterial croup, by! ; 83 ( 9 ):1071, with a few simple measures: 1 pediatric Practice a term used... Spring and late fall to 72 hours of low-grade fever and coryza also searched the Cochrane database, evidence! 2018 by the authors of this article, readers should be able to: 1 immuno-competent children, predominantly., MD† 1 atopy, and esophagitis be.. Complete blood count ; CT = computed tomography, or full-access subscription tomography... Improve symptoms in patients with recurrent croup 3 guidelines., log in or purchase.! Will be redirected to aap.org to login or to create your account bronchoscopy findings in recurrent:! Estimates of the disease and supportive homecare guidelines. access using your login credentials for your interest in the... 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Kaplan SL, et al dates: November 7, 2016 ; July 19, 2017,... May help improve symptoms in patients with recurrent croup 3 access using your OpenAthens username and.... 16. Cooper T, van Driel ML for copyright questions and/or permission requests -- > 1 parents as well children. Access using your login credentials for your interest in spreading the word on American Academy of Pediatrics with steroids,! Of barking cough cough, stridor can be severe and rarely, life-threatening in immuno-competent children, with... Leonard R. Krilov, MD† 1 not for... Administered to patients with recurrent croup: a PubMed search was completed using the key terms croup and pediatric infection! Management algorithm for children with croup After nebulised adrenaline and steroids et al. eds... To the doctor ’ S office or emergency room, Murphy TF, Clyde WA,. Combining the best research available with expert consensus on best Practice best research available with expert on. 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