In this section
Acute upper airway obstruction
Inhaled foreign body
Criteria Led Discharge
Differential diagnoses see
Acute upper airway obstruction)
Children with croup should have minimal examination. Do not examine throat. Do not upset child further.
Risk factors for severe croupPre-existing narrowing of upper airways
Previous admissions with severe croup
<6 months, rare <3 months of age. Consider alternative diagnosis. Acute upper airway obstruction.
Increasing irritability and/or lethargy
Stridor only when active or upset
Some stridor at rest
Stridor present at rest
Increased Resp rate
Marked increase or decrease
Accessory Muscle Use
None or minimal
Moderate chest wall retraction
Marked chest wall retraction
No oxygen requirement
No oxygen requirement
Hypoxemia is a late sign of significant upper airways obstruction
* The loudness of the stridor is not a good guide to the severity of the obstruction.
Children with cough only do not require treatment.
Steroids have been shown to decrease the length of hospital stay, need for nebulised Adrenaline and other interventions.
Drug Doses link
Mild to Moderate Croup
Prednisolone 1mg/kg, AND prescribe a second dose for the next evening.
a single dose of Oral Dexamethasone 0.15mg/kg.
(NB. Oral dexamethasone suspension ONLY available in hospitals, NOT available at commercial pharmacies)
Observe for half an hour post steroid administration. Discharge once stridor-free at rest.
Nebulised adrenaline: 5 mL of 1:1000 (5mg) adrenaline, undiluted.
Give 0.6mg/kg (max 12mg) IM/IV dexamethasone
If good improvement, observe for 4 hours post adrenaline. Consider discharge once stridor free at rest.
Improvement then deterioration
Give further doses of adrenaline. Consider admission/transfer as appropriate.
Reconsider diagnosis. Acute upper airway obstruction.
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
Parents should be advised and able to seek help if stridor at rest regardless of whether they have received steroids
Parent information sheet:
Children with croup are usually admitted under the General Paediatric Team.
Consider ICU review of any child admitted to RCH requiring frequent nebulised adrenaline, or treatment above to comfort level of the medical staff and/or ward.
Last updated April 2011