JOHN F. SULLIVAN, DO, is a second-year resident at the Jacksonville Family Medicine Residency Program, Naval Hospital Jacksonville. Glucocorticoids for croup. Symptoms and signs differentiating croup and epiglottitis. Viral croup: diagnosis and a treatment algorithm. 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. Rudinsky SL, Sharieff GQ, Law W, Kanegaye JT. Klassen TP. Rowe BH, Thank you for your interest in spreading the word on American Academy of Pediatrics. children by a hoarse voice; dry, barking cough; inspiratory stridor; Urgent care or emergency department treatment of croup depends on the patient's degree of respiratory distress. Liang Y, Previous: Effectiveness and Safety of Celecoxib for the Treatment of Rheumatoid Arthritis, Next: Top 20 Research Studies of 2017 for Primary Care Physicians, Home Adapted with permission from Westley CR, Cotton EK, Brooks JG. Consider evaluation and treatment for allergies Give Dexamethasone 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 It is more common in boys than in girls (1.5:1 ratio). Pediatr Emerg Care 2005; 21:359. 2007;28(6):401–407. If wheezing is present, it is typically mild; substantial wheezing should prompt evaluation for alternate diagnoses. Marx A, Placing the child in a comfortable position may help improve the evaluation and treatment process. Enlarge Coticchia JM. Feigin & Cherry's Textbook of Pediatric Infectious Diseases. J Pediatr. *Division of Pediatric Infectious Diseases, UMDNJ-Robert Wood Johnson School of Medicine, New Brunswick, NJ. Klassen TP, 5 PCR testing has been shown to decrease the rate of radiographs ordered in the ED but has not been shown to decrease antibiotic use, length of stay in the ED, or blood or urine testing. 2. A randomized trial of a single dose of oral dexamethasone for mild croup. Murphy TF, 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. Croup is a common respiratory illness of the larynx, trachea, and bronchi that leads to inspiratory stridor and a barking cough. Lavine E, Bronchoscopy findings in recurrent croup: a systematic review and meta-analysis. Cherry JD. Lavine E, Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial. J Infect Dis. Enlarge The Advanced Pediatric Life Support (APLS) course of the American Academy of Pediatrics and the American College of Emergency Physicians recommends treatment with corticosteroids. Russell KF, Liang Y, O.Gorman K, Johnson DW, Klassen TP. Mayo Clin Proc. CMAJ. Croup: an overview. Nebulized epinephrine for croup in children. Specifically, distinguishing it from epiglottitis is important because the treatment and prognosis of these conditions are substantially different.7 Although both conditions commonly present as cough, fever, and dyspnea, epiglottitis is 10 times more likely to present as sore throat.7 The incidence of epiglottitis has decreased 10-fold with widespread Haemophilus influenzae type B vaccination, but it is still important to distinguish it from croup because of potentially rapid deterioration in patients with epiglottitis.19 In patients admitted to the intensive care unit, cough is highly sensitive and specific for distinguishing croup from epiglottitis, whereas drooling is highly sensitive and specific for distinguishing epiglottitis.20, High fever, barking cough, respiratory distress, and rapid deterioration, Neck radiography (irregular tracheal mucosa) and CBC, Acute onset of barking cough, stridor, and hoarseness, Acute onset of dysphagia, odynophagia, drooling, high fever, anxiety, and muffled voice, Neck radiography (thickened epiglottis) and CBC, Neck radiography, neck CT, and airway endoscopy, Recurrent episodes of barking cough and stridor, Fever, drooling, dysphagia, odynophagia, and neck pain, Neck radiography (bulging posterior pharyngeal wall), neck CT, and CBC. Klassen TP, Watson T. 1978;132(5):485. The most Moderate to severe croup will generally require a trip to the doctor’s office or emergency room. et al. Am J Dis Child. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Zoorob R, Clyde WA Jr, Johnson DW. Although gastroesophageal reflux disease and asthma are highly prevalent in patients with recurrent croup, neither is associated with significant bronchoscopy findings. Leonard R. Krilov, MD† 1. Symptoms and signs differentiating croup and epiglottitis. Kaditis AG. 5. Pediatric Respiratory Emergencies. and atypical agents also have been identified. Lee DR, 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. Pediatric hospitalizations for croup (laryngotracheo-bronchitis): biennial increases associated with human parainfluenza virus 1 epidemics. A Cochrane review showed that nebulized epinephrine reduces symptom scores at 30 minutes, but not at two and six hours; however, it is associated with reduced length of hospitalization.25 There was no initial difference between nebulized racemic epinephrine and L-epinephrine, although L-epinephrine was more effective at two hours because of its longer effects. Objectives After completing this article, readers should be able to: 1. Mild croup is characterized by the presence of stridor without intercostal retractions, whereas moderate‐to‐severe croup is accompanied by increased work of breathing. In: Cherry JD, Demmler-Harrison GJ, Kaplan SL, et al., eds. Croup. Kwong K, laryngotracheitis, spasmodic croup, bacterial tracheitis, Australian Family Physician, 37(6 Spec No), 14-20. Humidified air inhalation for treating croup: a systematic review and meta-analysis. The term “croup syndrome” refers to a group of diseases that Kaditis AG, agents alone, whereas both bacterial and viral agents may be This content is owned by the AAFP. Recurrent croup presentation, diagnosis, and management. Knutson D, Little P. 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). Sidani M, 11. Tanou K, Evidence based guideline for the management of croup. If you have a subscription you may use the login form below to view the article. Klassen TP, O'Gorman K, The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Glucocorticoids for croup. Am Fam Physician. Cherry JD. 14. Steeple sign: not specific for croup. such as laryngotracheobronchitis and laryngotracheobronchopneumonitis. Cates CJ, Pediatrics 1996; 97:463. Taherahmadi H, Sterkel R, Clarke MJ, BMJ Clin Evid. Woods CR, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. Nebulized epinephrine for croup in children. New Vaccine Surveillance Network. Corticosteroids should be administered to patients with croup of any severity. Conlon B, Kalampouka E, Viral croup: diagnosis and a treatment algorithm. ; We also searched the Cochrane database, Essential Evidence Plus, and the National Guideline Clearinghouse. Croup is a condition that causes a swelling of the voice box (larynx) and windpipe (trachea). Denny FW, Eboriadou M, Chryssanthopoulou D, Stamoulis P, et al. 2006;295(11):1274–1280. Török TJ, 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. Russell K, Access to this article can also be purchased. Consider evaluation for GERD and initiation of anti-reflux medications in patients with prolonged or recurrent croup 3. 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. DUSTIN K. SMITH, DO; ANDREW J. MCDERMOTT, MD; and JOHN F. SULLIVAN, DO, Naval Hospital Jacksonville, Jacksonville, Florida. Parainfluenza virus infection of young children: estimates of the population-based burden of hospitalization. Klassen TP, Watters LK, Feldman ME, et al. Croup is a co mmon illness in young children. Coates AL, McGuire T, Dexamethasone, given orally as a single dose at 0.6 mg/kg, is highly efficacious in treating croup … 2013;185(15):1317–1323. El-Hakim H. The diagnosis is primarily based on clinical findings; imaging studies may be useful in selected cases. 26. Laboratory studies are seldom needed for diagnosis of croup. In addition, references in these resources were searched. Croup often starts, as many respiratory infections do, with a runny nose, fever, and a red, sore throat. 2018 May 1;97(9):575-580. Da Silva Z, Endotracheal intubation is rare … varies in anatomic involvement and etiologic agents and includes Török TJ, A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. Clin Pediatr (Phila). 20. Pediatric hospitalizations for croup (laryngotracheo-bronchitis): biennial increases associated with human parainfluenza virus 1 epidemics. 1.Philadelphia, Pa.: Elsevier Saunders; 2014:241–260.... 2. Humidified air inhalation for treating croup: a systematic review and meta-analysis. Sabbagh A, Atypical croup: association with airway lesions, atopy, and esophagitis. 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