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Croup: Approach to management

Author
Charles R Woods, MD, MS
Section Editors
Sheldon L Kaplan, MD
Anna H Messner, MD
Deputy Editor
Carrie Armsby, MD, MPH

INTRODUCTION

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".)

SEVERITY ASSESSMENT

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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Literature review current through: Aug 2015. | This topic last updated: Apr 17, 2015.
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