Croup .

Croup (laryngotracheitis) is a common childhood disease that is usually caused by a virus. It is characterized by the sudden onset of a seal-like barking cough usually accompanied by stridor (predominantly inspiratory), hoarse voice, and respiratory distress due to upper airways obstruction. Symptoms are usually worse at night. There may be a fever up to 40°C.

There is often a preceding 1–4-day history of a non-specific cough, rhinorrhoea, and fever.

Croup most commonly affects children 6 months to 3 years of age, with a peak incidence during the second year of life.

Mild:

Occasional barking cough and no audible stridor at rest.

No or mild suprasternal and/or intercostal recession.

The child is happy and is prepared to eat, drink, and play.

Moderate:

Frequent barking cough and easily audible stridor at rest.

Suprasternal and sternal wall retraction at rest.

No or little distress or agitation.

The child can be placated and is interested in its surroundings.

Severe:

Frequent barking cough with prominent inspiratory (and occasionally, expiratory) stridor at rest.

Marked sternal wall retractions.

Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia).

Tachycardia occurs with more severe obstructive symptoms and hypoxaemia.

Impending respiratory failure may develop regardless of the severity of the symptoms:

Change in mental state, such as lethargy and listlessness or decreased level of consciousness.

Dusky appearance.

Tachycardia.

In children with impending respiratory failure, breathing may be laboured, a barking cough may not be prominent, stridor at rest may be hard to hear, and sternal wall retractions may not be marked. A child who appears to be deteriorating but whose stridor appears to be improving has worsening airways obstruction and is at high risk of complete airway occlusion.

A child should be immediately admitted when presenting with:

Moderate or severe croup, or impending respiratory failure.

A serious disorder such as epiglottitis, bacterial tracheitis, peritonsillar abscess, retropharyngeal abscess, foreign body or angioneurotic oedema.

Mild croup can usually be managed at home. However, reasons for admission include: a history of severe obstruction, age less than 6 months, immunocompromised, an inadequate fluid intake, an uncertain diagnosis, a poor response to initial treatment, parental anxiety, no transport, or living far from the hospital.

All children with mild, moderate, or severe croup should receive a single dose of oral dexamethasone (0.15 mg per kg body weight).

Oral prednisolone (1–2 mg per kg body weight) is an alternative if dexamethasone is not available. A second dose should be considered if residual symptoms of stridor are still present the following day.

Croup is self limiting and symptoms usually resolve within 48 hours.
The use of paracetamol or ibuprofen to control fever and pain should be advised, and arrangements made to review the child within a few hours. Parents should be advised to seek urgent medical advice if there is any deterioration.

G. MOHAN.