Bottom Line Recommendations: Croup

A short summary of the latest knowledge related to the diagnosis and management of pediatric emergency conditions.

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Last Updated
Aug 2023

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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. Consider other causes of upper airway obstruction such as bacterial tracheitis, epiglottitis and retropharyngeal abscess in children presenting with severe symptoms and a transient or lack of response to croup treatment.

  • X-rays are rarely necessary to confirm the diagnosis of croup.
  • Symptoms are triggered by a viral infection, antibiotics are not effective.
  • A single dose of dexamethasone 0.15 to 0.6 mg/kg (MAX 12 mg/dose) PO should be given to ALL children who present to the emergency department with croup.
  • Minimize interaction and place the child in a position of comfort (e.g., caregiver’s lap), as agitation can precipitate significant respiratory distress.