Croup: Approach to management
- Charles R Woods, MD, MS
Charles R Woods, MD, MS
- Professor of Pediatrics
- University of Louisville School of Medicine
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 caused by parainfluenza virus. (See "Croup: Clinical features, evaluation, and diagnosis".)
The treatment of croup has changed significantly since the 1980s. Corticosteroids and nebulized epinephrine have become the cornerstones of therapy. Substantial clinical evidence supports the efficacy of these interventions [1-5]. The impact also is evident in the decrease in annual hospital admissions for croup in children in the United States between 1979 and 1982, and 1994 and 1997 (from 2.8 to 2.1 per 1000 for children <1 year and from 1.8 to 1.2 per 1000 children for children 1 to 4 years) .
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".)
The treatment of croup and the setting in which the child is initially evaluated depend upon the severity of symptoms and the presence of risk factors for rapid progression. 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. (See "Croup: Pharmacologic and supportive interventions".)
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.
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- Severity assessment
- - Westley croup score
- - Respiratory failure
- PHONE TRIAGE
- MILD CROUP
- Home treatment
- Outpatient treatment
- MODERATE TO SEVERE CROUP
- Supportive care
- - Monitoring
- - Fluids
- - Intubation
- Discharge to home
- - Indications
- - Interventions
- - Infection control
- - Discharge criteria
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Mild symptoms
- Moderate to severe symptoms