Croup: Approach to management
- Charles R Woods, MD, MS
Charles R Woods, MD, MS
- Professor of Pediatrics
- University of Louisville School of Medicine
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Anna H Messner, MD
Anna H Messner, MD
- Section Editor — Pediatric Otolaryngology
- Professor of Otolaryngology/Head & Neck Surgery and Pediatrics
- Stanford University
Croup (laryngotracheitis) is a respiratory illness characterized by inspiratory stridor, barking cough, and hoarseness. It typically occurs in children six months to three years of age and is chiefly caused by parainfluenza virus. (See "Croup: Clinical features, evaluation, and diagnosis".)
Most children with croup who seek medical attention have a mild, self-limited illness and can be successfully managed as outpatients. The clinician must be able to identify children with mild symptoms, who can be safely managed at home, and those with moderate to severe croup or rapidly progressing symptoms, who require full evaluation and possible treatment in the office or emergency department setting. (See 'Severity assessment' below and 'Outpatient treatment' below.)
There is no definitive treatment for the viruses that cause croup. Pharmacologic therapy is directed toward decreasing airway edema, and supportive care is directed toward the provision of respiratory support and the maintenance of hydration. Corticosteroids and nebulized epinephrine are the cornerstones of therapy; their use is supported by substantial clinical evidence. (See 'Initial treatment' below and "Croup: Pharmacologic and supportive interventions".)
The approach to the management of croup will be discussed below. The clinical features and evaluation of croup, and the evidence supporting the use of the pharmacologic and supportive interventions included below are discussed separately. (See "Croup: Clinical features, evaluation, and diagnosis" and "Croup: Pharmacologic and supportive interventions".)
This initial step in the management of a child with croup is assessing severity of illness. The first contact with the healthcare system may occur by phone and the healthcare provider must be able to distinguish children with more severe symptoms who need immediate medical attention from those who can be managed at home. (See 'Telephone triage' below.)
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- SEVERITY ASSESSMENT
- Telephone triage
- Croup severity score
- MILD CROUP
- Home treatment
- Outpatient treatment
- MODERATE TO SEVERE CROUP
- Setting and pace of treatment
- Initial treatment
- Observation and disposition
- - Discharge to home
- - Indications for hospital admission
- Inpatient management
- - Supportive care
- - Respiratory care
- - Repeated corticosteroid dosing
- - Monitoring
- - Infection control
- - Discharge criteria
- - Atypical course
- Recurrent symptoms
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS