Acute Inflammatory Upper Airway – Croup

July 10, 2021

Definition of Croup:

  • Upper airway obstruction caused mainly by a viral infection characterized by a harsh barking cough.
  • Mostly at night or early morning
  • With or without fever

Cause (Etiology):

  • In most cases, it is caused by a viral infection of the upper airways (vocal cords, larynx), and the most common viruses are parainfluenza viruses (1,2,3) which is the cause of 75% of Croup cases.
  • Other viruses such as Influenza (A, B), adenovirus, RSV, etc., causes 20% of the cases and Influenza is the most severe type.

Age and Sex:

  • Mostly between 3 mo. – 5 yrs. of age and the peak is at 2 yrs. of age.
  • More common in males than females
  • More common in late fall and winter
  • 15% of cases suffer recurrence attacks

Clinical Presentation:

  • Starts as a common cold
  • In some cases it starts with irritability at night, harsh barking cough, inspiratory stridor, noisy breathing, agitation.
  • Some cases get fever but most cases don’t get fever
  • Some cases have difficulty swallowing, in addition to vomiting
  • Most children with a hoarse of voice

Complications of Croup:

  • Cases are mostly mild and moderate with little complications but severe cases may need hospitalization and in rare cases intubation – ventilation might be needed.
  • Rare complications include: Otitis media, bronchitis, pneumonia and bacterial tracheitis.

Home treatment:

  • most Croup (infectious) cases can be treated at home by calming the child or doing something to decrease crying, in addition to giving the child paracetamol syrup.
  • The use of cool or cold mist at home might help however there is no evidence that it improves the cases but can generally be tried at home.

At the Pediatric or Emergency clinic:

  • Racemic epinephrine is accepted: Adrenaline sol with saline for Neb. (0.5 ml adrenaline + 3 ml saline). Given every 20-30 mins for 2-3 times
  • Dexamethasone: as 0.3 – 0.6 mg / kg. Should be given as single injected dose or orally.
  • No use of antibiotics
  • Besides the previous treatment, Humidity oxygen is also effective in the E.R.
  • Hospitalization is needed for severe cases.


Dr Mousa Hassan Saleh Saadah

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