Croup

Question 1

What virus is the main cause for croup?

Answer 1

Parainfluenza virus

Question 2

What time of year is it more common in?

Answer 2

Autumn

Question 3

At what ages is the peak incidence of croup?

Answer 3

Peak incidence at 6 months - 3 years

Question 4

What are the features of stridor?

Answer 4

• Stridor
• Barking cough (worse at night)
• Fever
• Coryzal symptoms

Question 5

CKS have based their classification of croup on the Alberta Medical Association 2008 Guidelines on the Diagnosis and Management of Croup

Why is the Alberta Medical Association 2008 Guidelines on the Diagnosis and Management of Croup preferred by CKS over the Westley Croup Score?

Answer 5

The Alberta Medical Association 2008 Guidelines are more applicable to clinical situations.

The Westley Croup Score was derived mainly for research

Question 6

What does the CKS define as mild croup?

Answer 6

• Occasional barking cough
• 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

Question 7

What does the CKS define as moderate croup?

Answer 7

• Frequent barking cough
• 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

Question 8

What does the CKS define as severe croup?

Answer 8

• Frequent barking cough
• 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

Question 9

When should a child with Croup be admitted into hospital?

Answer 9

• When they have moderate to severe croup.
• < 6 months of age
• Known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome
• Uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)

Question 10

How should someone with croup be managed?

Answer 10

Emergency treatment

• High-flow oxygen
• Nebulised adrenaline

CKS recommend giving a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity

Prednisolone is an alternative if dexamethasone is not available