A common childhood upper-airway disorder, croup is among several respiratory illnesses that require pediatricians and other healthcare providers to make an accurate differential diagnosis to ensure appropriate treatment. It occurs most commonly in children aged between 6 months and 3 years and during the late autumn months, but sporadic cases can also occur any time of year and in older children.1,2
Although most cases of croup resolve on their own, children with even mild disease are now routinely treated with corticosteroids and those with more moderate to severe disease with immediate nebulized adrenaline.2,3 Very few children require hospitalization, with only about 1% to 8% of children needing hospitalization.2,3 Despite this, most children with symptoms of croup who present to the emergency department (ED) have only mild disease that does not require hospitalization.2,3
This article provides pediatricians and other pediatric healthcare providers with quick reference to the diagnosis and management of croup. The goal is to help pediatricians accurately diagnose and treat these children as well as educate their parents on the symptoms of the illness to help them know when to call their physician or when a visit to the ED is warranted.
Etiology and diagnosis
Symptoms of croup can be similar to other respiratory diseases, so making the differential diagnosis is important to both treat appropriately and avoid unnecessary treatment. Most cases of croup are from a viral infection (called laryngotracheitis) or are spasmodic (called recurrent croup), although other conditions can mimic the symptoms of croup and need to be considered in making the differential diagnosis (Table 1).2
This article will focus on the diagnosis and treatment of croup, however pediatricians should be aware of recurrent croup and the potential for an underlying condition that may be masked by the persistence of croup symptoms (Table 2).4 For children with symptoms of recurrent croup, referral to an otolaryngologist is advised.