Croup is the most common cause of upper airway obstruction in children. It is characterized by acute onset of barky cough +/- stridor. The typical age of presentation is between 6 months and 5 years with a peak around 2 years. In children with severe symptoms, poor or
transient response to croup treatment, OR presentation outside the typical age range, consider alternative causes of upper airway obstruction, including foreign body, bacterial tracheitis, epiglottitis, and retropharyngeal abscess.
• Give a single dose of PO dexamethasone to ALL children presenting to the ED with croup. Evidence supports 0.15–0.6 mg/kg, but 0.6 mg/kg (MAX 12 mg) is the most widely used dose in practice.
• Use nebulized epinephrine in SEVERE croup to provide transient improvement in upper airway obstruction.
• If oral steroids are not tolerated or are contraindicated, use budesonide 2 mg nebulized (can be administered together with epinephrine, if required).
• Minimize interaction and place the child in a position of comfort (e.g., caregiver’s lap) in a quiet environment, as agitation can precipitate significant respiratory distress.
• X-rays are not routinely needed to diagnose croup but may be useful when considering other diagnoses.
• Do not use antibiotics as croup symptoms are triggered by a viral infection. Treat fever, if required.