🧭 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 classically worse at night and preceded by a day or two of coryza and low-grade fever:

• A sudden-onset barking, seal-like cough

• Hoarseness

• Inspiratory stridor

• A variable degree of respiratory distress

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, respiratory syncytial virus (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). 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

• 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.

Inside the full topic 🔒 History🔒 Red Flags🔒 Examination🔒 Patient Explanation🔒 Investigations🔒 Management🔒 Non-pharmacological Treatment🔒 Pharmacological Treatment🔒 Special Notes🔒 Referral Pathways🔒 Take Home Messages

Sample topics are open to everyone in the Free Sample Bundle.

Part of The Ocean Library, 450+ structured clinical topics mapped to the primary care curriculum. Companion audio in Echo · one-page summary in The Scope.