GPAtlas🧭 When to suspect
Croup (acute laryngotracheobronchitis) is a common viral illness of early childhood in which inflammation and oedema of the subglottic larynx and trachea narrow the upper airway. The clinical signature is a sudden-onset barking, seal-like cough with hoarseness, inspiratory stridor and a variable degree of respiratory distress, classically worse at night and preceded by a day or two of coryza and low-grade fever.
It is most common between 6 months and 3 years, peaking in the second year of life, and is uncommon after 6 years. The usual culprit is parainfluenza virus (types 1 and 3), though influenza, RSV, adenovirus, rhinovirus and SARS-CoV-2 can all be responsible. Most cases are mild and self-limiting, settling within 48 hours (occasionally up to a week), and around 80% of children presenting with acute stridor and a cough have croup.
The two clinical priorities in primary care are to grade severity – which decides whether to treat at home or admit – and to recognise the rare mimics that masquerade as croup but threaten the airway: epiglottitis, bacterial tracheitis and an inhaled foreign body.
| Severity | Key features | Usual setting |
|---|---|---|
| Mild | Barking cough; no stridor or recession at rest (stridor only when upset); child active and feeding | Home after a single dose of steroid |
| Moderate | Barking cough with stridor and recession at rest; little or no agitation or lethargy | Steroid, then observe; consider admission |
| Severe | Stridor and recession at rest with agitation or lethargy, often tachycardia | Admit; steroid plus nebulised adrenaline |
| Impending respiratory failure | Tiring, increasing recession then asynchronous (see-saw) chest and abdominal movement, pallor or cyanosis, drowsiness; stridor may quieten as air entry falls | 999; anaesthetics and ENT |
Source: NICE
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.