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Key Resources

Bottom Line Recommendations: Croup  (2020)

Bottom Line Recommendations: Croup

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Johnson, DW. & TREKK Network

Johnson, DW. & TREKK Network

Bottom line recommendations for the treatment and management of croup.

Bottom line recommendations for the treatment and management of croup.

VIDEO: Croup in Kids

VIDEO: Croup in Kids

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Recommendations de Base: Laryngite Aigu  (2019)

Recommendations de Base: Laryngite Aigu

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Johnson, DW. & TREKK Network

Johnson, DW. & TREKK Network

Bottom line recommendations for the treatment and management of croup- French.

Bottom line recommendations for the treatment and management of croup- French.

Clinical guidelines

BMJ Best Practice: Croup  (2018)

BMJ Best Practice: Croup

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Bjornson C, Johnson DW,

Bjornson C, Johnson DW,

Summary of Practice Guidelines for Croup.

Summary of Practice Guidelines for Croup.

Acute management of croup in the emergency department  (2017)

Acute management of croup in the emergency department

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Ortiz-Alvarez O,

Ortiz-Alvarez O,

Acute management of croup in the emergency department.

Acute management of croup in the emergency department.

Summaries of systematic reviews

Cochrane Summary: Nebulized epinephrine for croup in children  (2013)

Cochrane Summary: Nebulized epinephrine for croup in children

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Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,

Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,

Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.

Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.

Cochrane Summary: Glucocorticoids for croup in children  (2018)

Cochrane Summary: Glucocorticoids for croup in children

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Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,

Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,

Objective: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years.

Objective: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years.

Cochrane Summary: Helium-oxygen (heliox) treatment for children with croup  (2018)

Cochrane Summary: Helium-oxygen (heliox) treatment for children with croup

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Moraa I, Sturman N, McGuire TM, van Driel ML,

Moraa I, Sturman N, McGuire TM, van Driel ML,

Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.

Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.

Summary: Evidence for Clinicians: Nebulized epinephrine for croup in children  (2015)

Summary: Evidence for Clinicians: Nebulized epinephrine for croup in children

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Kawaguchi A, Joffe A,

Kawaguchi A, Joffe A,

Expert commentary on the Cochrane Review on nebulized epinephrine for reducing symptoms in children with severe croup. 

Expert commentary on the Cochrane Review on nebulized epinephrine for reducing symptoms in children with severe croup. 

Overviews of systematic reviews

Cochrane Overview: The Cochrane Library and the treatment of croup in children: an overview of reviews  (2010)

Cochrane Overview: The Cochrane Library and the treatment of croup in children: an overview of reviews

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Bjornson, C, Russell, K, Foisy, M, Johnson, D,

Bjornson, C, Russell, K, Foisy, M, Johnson, D,

Objective: To synthesize the evidence currently in the Cochrane Database of Systematic Reviews (CDSR) related to the clinical effectiveness and applicability of four treatments for croup - glucocorticoids, epinephrine, heliox and humidified air.

Objective: To synthesize the evidence currently in the Cochrane Database of Systematic Reviews (CDSR) related to the clinical effectiveness and applicability of four treatments for croup - glucocorticoids, epinephrine, heliox and humidified air.

Cochrane Overview: Evidence Summary: Croup  (2014)

Cochrane Overview: Evidence Summary: Croup

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Alberta Research Centre for Health Evidence (ARCHE),

Alberta Research Centre for Health Evidence (ARCHE),

The purpose of this document is to describe the effectiveness of four treatment options, based on a 2012 Overview of Reviews.

The purpose of this document is to describe the effectiveness of four treatment options, based on a 2012 Overview of Reviews.

Systematic reviews

Cochrane Systematic Review: Nebulized epinephrine for croup in children  (2013)

Cochrane Systematic Review: Nebulized epinephrine for croup in children

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Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,

Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,

Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.

Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.

Cochrane Systematic Review: Humidified air inhalation for treating croup  (2006)

Cochrane Systematic Review: Humidified air inhalation for treating croup

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Moore, M, Little, P,

Moore, M, Little, P,

Objective: To assess the efficacy of humidified air in the treatment of croup.

Objective: To assess the efficacy of humidified air in the treatment of croup.

Cochrane Systematic Review: Glucocorticoids for croup

Cochrane Systematic Review: Glucocorticoids for croup

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Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP.

Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP.

Objectives: To determine the effect of glucocorticoids for children with croup.

Objectives: To determine the effect of glucocorticoids for children with croup.

Cochrane Systematic Review: Heliox for croup in children

Cochrane Systematic Review: Heliox for croup in children

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Moraa I, Sturman N, McGuire T, van Driel ML.

Moraa I, Sturman N, McGuire T, van Driel ML.

Objectives: To examine the effect of heliox on relieving symptoms and signs of croup, as determined by a croup score (a tool for measuring the severity of croup).To examine the effect of croup on rates of admission or intubation (or both), through comparisons of heliox with placebo or any active intervention(s) in children with croup.

Objectives: To examine the effect of heliox on relieving symptoms and signs of croup, as determined by a croup score (a tool for measuring the severity of croup).To examine the effect of croup on rates of admission or intubation (or both), through comparisons of heliox with placebo or any active intervention(s) in children with croup.

Cochrane Systematic Review: Humidified air inhalation for treating croup

Cochrane Systematic Review: Humidified air inhalation for treating croup

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Moore M, Little P.

Moore M, Little P.

Objectives: To assess the efficacy of humidified air in the treatment of croup.

Objectives: To assess the efficacy of humidified air in the treatment of croup.

Cochrane Systematic Review: Nebulized epinephrine for croup in children

Cochrane Systematic Review: Nebulized epinephrine for croup in children

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Bjornson C, Russell K, Vandermeer B, Klassen TP, Johnson DW.

Bjornson C, Russell K, Vandermeer B, Klassen TP, Johnson DW.

Objectives: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.

Objectives: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.

Review: Croup in children  (2013)

Review: Croup in children

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Bjornson CL, Johnson DW,

Bjornson CL, Johnson DW,

Objective:This review will address the diagnosis and management of croup in children, specifically focusing on clinical assessment of disease severity to guide management decisions.

Objective:This review will address the diagnosis and management of croup in children, specifically focusing on clinical assessment of disease severity to guide management decisions.

Cochrane Systematic Review: Glucocorticoids for croup in children  (2018)

Cochrane Systematic Review: Glucocorticoids for croup in children

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Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,

Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,

Objective: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years. Published: 2018.

Objective: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years. Published: 2018.

Cochrane Systematic Review: Heliox for croup in children  (2018)

Cochrane Systematic Review: Heliox for croup in children

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Moraa I, Sturman N, McGuire TM, van Driel ML,

Moraa I, Sturman N, McGuire TM, van Driel ML,

Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.

Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.

Cochrane Systematic Review: Antibiotics for preventing complications in children with measles

Cochrane Systematic Review: Antibiotics for preventing complications in children with measles

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Kabra SK, Lodha R

Kabra SK, Lodha R

OBJECTIVES: To assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality.

OBJECTIVES: To assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality.

Key studies

Key Study: Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial  (2006)

Key Study: Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial

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Scolnik, D, Coates, AL, Stephens, D, Da Silva, Z, Lavine, E, Schuh, S,

Scolnik, D, Coates, AL, Stephens, D, Da Silva, Z, Lavine, E, Schuh, S,

Objective: To determine whether a significant difference in the clinical Westley croup score exists in children with moderate to severe croup who were admitted to the emergency department and who received either 100% humidity or 40% humidity via nebulizer or blow-by humidity.

Objective: To determine whether a significant difference in the clinical Westley croup score exists in children with moderate to severe croup who were admitted to the emergency department and who received either 100% humidity or 40% humidity via nebulizer or blow-by humidity.

Key Study: A randomized trial of a single dose of oral dexamethasone for mild croup  (2004)

Key Study: A randomized trial of a single dose of oral dexamethasone for mild croup

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Bjornson, CL, Klassen, TP, Williamson, J, Brant, R, Mitton, C, Plint, A, Bulloch, B, Evered, L, Johnson, DW,

Bjornson, CL, Klassen, TP, Williamson, J, Brant, R, Mitton, C, Plint, A, Bull...

Objective: The primary outcome was a return to a medical care provider for croup within seven days after treatment. The secondary outcome was the presence of ongoing symptoms of croup on days 1, 2, and 3 after treatment. Other outcomes included economic costs, hours of sleep lost by the child, and stress on the part of the parent in relation to the child's illness.

Objective: The primary outcome was a return to a medical care provider for croup within seven days after treatment. The secondary outcome was the presence of ongoing symptoms of croup on days 1, 2, and 3 after treatment. Other outcomes included economic costs, hours of sleep lost by the child, and stress on the part of the parent in relation to the child's illness.

Key Study: Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing  (2000)

Key Study: Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing

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Rittichier, KK, Ledwith, CA,

Rittichier, KK, Ledwith, CA,

Objective: Steroid use for the treatment of croup has been supported by several studies, although few have addressed the use of oral dexamethasone for outpatient management. The efficacy of oral (PO) versus intramuscular (IM) dosing of dexamethasone in the outpatient treatment of moderate croup are compared in this study.

Objective: Steroid use for the treatment of croup has been supported by several studies, although few have addressed the use of oral dexamethasone for outpatient management. The efficacy of oral (PO) versus intramuscular (IM) dosing of dexamethasone in the outpatient treatment of moderate croup are compared in this study.

Key Study: Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial  (1998)

Key Study: Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial

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Klassen, TP, Craig, WR, Moher, D, Osmond, MH, Pasterkamp, H, Sutcliffe, T, Watters, LK, Rowe, PC,

Klassen, TP, Craig, WR, Moher, D, Osmond, MH, Pasterkamp, H, Sutcliffe, T, Wa...

Objective: To determine the effectiveness of 3 glucocorticoid regimens in patients with croup.

Objective: To determine the effectiveness of 3 glucocorticoid regimens in patients with croup.

Key Study: A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup  (1998)

Key Study: A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup

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Johnson, DW, Jacobson, S, Edney, PC, Hadfield, P, Mundy, ME, Schuh, S,

Johnson, DW, Jacobson, S, Edney, PC, Hadfield, P, Mundy, ME, Schuh, S,

Objective: To study how budesonide compares with dexamethasone, the conventional therapy for croup, and whether either reduces the rate of hospitalization.

Objective: To study how budesonide compares with dexamethasone, the conventional therapy for croup, and whether either reduces the rate of hospitalization.

Key Study: Oral and inhaled steroids in croup - A randomized, placebo-controlled trial  (1995)

Key Study: Oral and inhaled steroids in croup - A randomized, placebo-controlled trial

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Geelhoed, GC, Macdonald, WB,

Geelhoed, GC, Macdonald, WB,

Objective: To compare the efficacy of oral dexamethasone and inhaled budesonide in children hospitalized with croup, using a three-way, double blind, randomized, placebo-controlled clinical trial design.

Objective: To compare the efficacy of oral dexamethasone and inhaled budesonide in children hospitalized with croup, using a three-way, double blind, randomized, placebo-controlled clinical trial design.

Key Study: Placebo-controlled trial of prednisolone in children intubated for croup  (1992)

Key Study: Placebo-controlled trial of prednisolone in children intubated for croup

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Tibballs, J, Shann, FA, Landau, LI,

Tibballs, J, Shann, FA, Landau, LI,

Objective: To study the effect of prednisolone on two clinical endpoints--the duration of intubation and the need for reintubation.

Objective: To study the effect of prednisolone on two clinical endpoints--the duration of intubation and the need for reintubation.

Key study: Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study  (2016)

Key study: Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study

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Eghbali A, Sabbagh A, Bagheri B, Taherahmadi H, Kahbazi M

Eghbali A, Sabbagh A, Bagheri B, Taherahmadi H, Kahbazi M

Objective: The objective of this study was to compare the effect of L-epinephrine plus dexamethasone vs. dexamethasone for treatment of croup in children.

Objective: The objective of this study was to compare the effect of L-epinephrine plus dexamethasone vs. dexamethasone for treatment of croup in children.

Key study: The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial  (2013)

Key study: The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial

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Garbutt JM, Conlon B, Sterkel R, Baty J, Schechtman KB, Mandrell K, Leege E, Gentry S, Stunk RC

Garbutt JM, Conlon B, Sterkel R, Baty J, Schechtman KB, Mandrell K, Leege E, ...

Objective: Our objective was to compare the effectiveness of prednisolone 2 mg/kg for 3 days, a treatment regimen already commonly prescribed by pediatricians in our community; with one dose of dexamethasone 0.6 mg/kg, a treatment regimen known to be effective in the ED setting, for children with mild or moderate croup diagnosed at an office visit.

Objective: Our objective was to compare the effectiveness of prednisolone 2 mg/kg for 3 days, a treatment regimen already commonly prescribed by pediatricians in our community; with one dose of dexamethasone 0.6 mg/kg, a treatment regimen known to be effective in the ED setting, for children with mild or moderate croup diagnosed at an office visit.

Key study: The comparison of oral and IM dexamethasone efficacy in croup treatment  (2013)

Key study: The comparison of oral and IM dexamethasone efficacy in croup treatment

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Soleimani G, Daryadel A, Ansari Moghadam A, Sharif MR

Soleimani G, Daryadel A, Ansari Moghadam A, Sharif MR

Objective: In this study, the efficacies of intramuscular and oral dexamethasone administration are compared for treatment of croup.

Objective: In this study, the efficacies of intramuscular and oral dexamethasone administration are compared for treatment of croup.

Key study: How fast does oral dexamethasone work in mild to moderately severe croup? A randomized double-blinded clinical trial  (2012)

Key study: How fast does oral dexamethasone work in mild to moderately severe croup? A randomized double-blinded clinical trial

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Dobrovoljac M, Geelhoed GC

Dobrovoljac M, Geelhoed GC

Objective: For children with croup controversy remains over dosage and time to onset of action of oral steroids. The Cochrane Collaboration and other reviews have suggested 0.6 mg/kg dexamethasone be used (despite some evidence that 0.15 mg/kg is effective) with no expectation of benefit before 4-6 h. This randomized double-blinded clinical trial examines whether 0.15 mg/kg dexamethasone works by 30 min. Published: 2012.

Objective: For children with croup controversy remains over dosage and time to onset of action of oral steroids. The Cochrane Collaboration and other reviews have suggested 0.6 mg/kg dexamethasone be used (despite some evidence that 0.15 mg/kg is effective) with no expectation of benefit before 4-6 h. This randomized double-blinded clinical trial examines whether 0.15 mg/kg dexamethasone works by 30 min. Published: 2012.

Key study: Seasonality patterns in croup presentations to emergency departments in Alberta, Canada: a time series analysis  (2011)

Key study: Seasonality patterns in croup presentations to emergency departments in Alberta, Canada: a time series analysis

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Rosychuk RJ, Klassen TP, Voaklander DC, Senthilselvan A, Rowe BH

Rosychuk RJ, Klassen TP, Voaklander DC, Senthilselvan A, Rowe BH

Objective: We examine the monthly patterns of young children who made croup-related visits to EDs in Alberta, Canada.

Objective: We examine the monthly patterns of young children who made croup-related visits to EDs in Alberta, Canada.

Key study: The effectiveness of local corticosteroids therapy in the management of mild to moderate viral croup  (2010)

Key study: The effectiveness of local corticosteroids therapy in the management of mild to moderate viral croup

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Eboriadou M, Chryssanthopoulou D, Stamoulis P, Damianidou L, Haidopoulou K

Eboriadou M, Chryssanthopoulou D, Stamoulis P, Damianidou L, Haidopoulou K

Objective: The purpose of this study was to determine whether local anti-inflammatory therapy with inhaled beclomethasone dipropionate is effective in the outpatient management of acute viral croup.

Objective: The purpose of this study was to determine whether local anti-inflammatory therapy with inhaled beclomethasone dipropionate is effective in the outpatient management of acute viral croup.

Key study: Croup presentations to emergency departments in Alberta, Canada: a large population-based study  (2010)

Key study: Croup presentations to emergency departments in Alberta, Canada: a large population-based study

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Rosychuk RJ, Klassen TP, Metes D, Voaklander DC, Senthilselvan A, Rowe BH

Rosychuk RJ, Klassen TP, Metes D, Voaklander DC, Senthilselvan A, Rowe BH

Objective: The objective of this study was to describe the epidemiology of croup presentations to EDs made by infants (

Objective: The objective of this study was to describe the epidemiology of croup presentations to EDs made by infants (

Key study: A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup  (2007)

Key study: A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup

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Chub-Uppakarn S, Sangsupawanich P

Chub-Uppakarn S, Sangsupawanich P

Objective: The aim of this study was to investigate the effectiveness of dexamethasone 0.15 mg/kg single dose compared with the recommended dose of 0.6 mg/kg for treatment of hospitalized children with moderate to severe croup.

Objective: The aim of this study was to investigate the effectiveness of dexamethasone 0.15 mg/kg single dose compared with the recommended dose of 0.6 mg/kg for treatment of hospitalized children with moderate to severe croup.

Key study: A case series of pediatric croup with COVID-19.  (2020)

Key study: A case series of pediatric croup with COVID-19.

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Venn AMR, Schmidt JM, Mullan PC.

Venn AMR, Schmidt JM, Mullan PC.

Objective: We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection.

Objective: We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection.

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TREKK croup story book

Posted: Feb 09, 2016  | Resource  | Team: News and Events 


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Storytelling helping children with croup

Posted: Nov 21, 2013  | Story  | Team: News and Events 


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Croup video

Posted: Dec 15, 2016  | Announcement  | Team: News and Events 


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Croup Storybooks

Posted: Feb 19, 2015  | Resource  | Team: News and Events 
Tags: Croup


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New video tells parents what to do about croup

Posted: Feb 13, 2017  | Announcement  | Team: News and Events 


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Couching health evidence in a story

Posted: Mar 18, 2016  | Announcement  | Team: News and Events 


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Dr. Terry Klassen on CTV Morning Live Winnipeg

Posted: Mar 13, 2017  | Announcement  | Team: News and Events 


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Does a child's cough sound like a barking seal? Could be croup

Posted: May 01, 2015  | Announcement  | Team: News and Events 
Tags: Croup, Infection


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Croup in children - a Canadian Medical Association Review

Posted: Oct 21, 2013  | Journal Club  | Team: News and Events 


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Updated resource - Croup Bottom Line Recommendations

Posted: Mar 21, 2019  | Announcement  | Team: News and Events 


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I Love to Read Month

Posted: Feb 18, 2020  | Announcement  | Team: News and Events 


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Dr. Terry Klassen on CTV Morning Live Winnipeg

Posted: Mar 13, 2017  | Announcement  | Team: News and Events 


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Gastroenteritis video wins runner-up prize

Posted: Jan 19, 2017  | Announcement  | Team: News and Events 


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OUTCH Study

Posted: Feb 19, 2016  | Announcement  | Team: News and Events 


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New bottom line recommendations for concussion on trekk.ca

Posted: Nov 05, 2014  | Announcement  | Team: News and Events 



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