Cooper T, Viral croup often presents similarly to an upper respiratory infection, with 12 to 72 hours of low-grade fever and coryza. Coates AL, J Paediatr Child Health. Croup: an 11-year study in a pediatric practice. In mild croup, a child may present with only a croupy cough and may just require parental guidance and reassurance, given alertness, baseline minimal respiratory distress, proper oxygenation, and stable fluid status. Clinical Practice Guidelines. Inpatient Treatment after Multi-Dose Racemic Epinephrine for Croup in the Emergency Department. laryngotracheobronchitis, and laryngotracheobronchopneumonitis. Clarke MJ, Differentiate epiglottitis from viral croup. Corticosteroids should be administered to patients with croup of any severity. 2018 May 1;97(9):575-580. The lung parenchyma is involved occasionally. Pediatrics 1996; 97:463. Randomized controlled trials have demonstrated that a single dose of oral, intramuscular, or intravenous dexamethasone improves symptoms and reduces return visits and length of hospitalization in children with croup of any severity. Am Fam Physician. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Croup is a co mmon illness in young children. O'Gorman K, Want to use this article elsewhere? 15. Recurrent croup presentation, diagnosis, and management. Oxygen should be administered to children with hypoxemia or severe respiratory distress. 2. laryngotracheitis, spasmodic croup, bacterial tracheitis, List the etiologic agents associated with viral croup. Lee CH, †Pediatric Infectious Diseases, Winthrop University Hospital, Mineola, NY. Collier AM, Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Epinephrine decreases symptom scores in children with moderate or severe croup and should be given at the recommended dose of 0.05 mL per kg of racemic epinephrine 2.25% (maximum dose = 0.5 mL) or 0.5 mL per kg of L-epinephrine 1:1,000 via nebulizer (maximum dose = 5 mL).25,26. 2014;49(5). 2004;351(13):1306–1313. Fundam Clin Pharmacol. Search dates: November 7, 2016; July 19, 2017; and December 27, 2017. The efficacy of nebulized budesonide in dexamethasone-treated outpatients with croup. Croup sometimes resembles more serious disease, and management options range from home treatment with mist to PICU admission. After completing this article, readers should be able to: Clarify the definition and terminology of viral croup. To see the full article, log in or purchase access. Zhao YD, Clinical Practice Guideline: The diagnosis, management and prevention of bronchiolitis. Fam Pract. N Engl J Med. 2014;9(3):733–747. Bagheri B, Da Silva Z, 22. Although there's no evidence of benefit from these practices, many parents believe that humid air or cool air helps a child's breathing. Sidani M, Hiebert JC, 2. Figure 1 provides an outpatient management algorithm for children with croup.6,14,21–26 Minimizing agitation in a symptomatic child can help improve symptoms. Humidified air inhalation does not improve symptoms in patients with moderate croup. *Division of Pediatric Infectious Diseases, UMDNJ-Robert Wood Johnson School of Medicine, New Brunswick, NJ. Viral croup: current diagnosis and treatment. Zoorob R, A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup ; Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial ; Oral dexamethasone in the treatment of coup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg ; Related Links et al. Pay Per Article - You may access this article (from the computer you are currently using) for 2 days for US$25.00. Croup. Williamson J, Croup. Eboriadou M, Chryssanthopoulou D, Stamoulis P, et al. Enlarge Croup is a common respiratory illness in children. Objectives Comfort or distract your child — cuddle, read a book or play a quiet game. A common childhood upper-airway disorder, croup is among several respiratory illnesses that require pediatricians and other healthcare providers to make an accurate differential diagnosis to ensure appropriate treatment. Coticchia JM. Croup: an 11-year study in a pediatric practice. What is Croup? Murphy TF, The Academy created the policy statem ent, "Classifying Recommendations for Clinical Practice Guidelines." J Pediatr. Little P. J Emerg Med. DUSTIN K. SMITH, DO; ANDREW J. MCDERMOTT, MD; and JOHN F. SULLIVAN, DO, Naval Hospital Jacksonville, Jacksonville, Florida. Pediatric hospitalizations for croup (laryngotracheo-bronchitis): biennial increases associated with human parainfluenza virus 1 epidemics. varies in anatomic involvement and etiologic agents and includes Clin Pediatr (Phila). Won YK, Garbutt JM, We do not capture any email address. Russell KF, Liang Y, O.Gorman K, Johnson DW, Klassen TP. Specifically, distinguishing it from epiglottitis is important because the treatment and prognosis of these conditions are substantially different.7 Although both conditions commonly present as cough, fever, and dyspnea, epiglottitis is 10 times more likely to present as sore throat.7 The incidence of epiglottitis has decreased 10-fold with widespread Haemophilus influenzae type B vaccination, but it is still important to distinguish it from croup because of potentially rapid deterioration in patients with epiglottitis.19 In patients admitted to the intensive care unit, cough is highly sensitive and specific for distinguishing croup from epiglottitis, whereas drooling is highly sensitive and specific for distinguishing epiglottitis.20, High fever, barking cough, respiratory distress, and rapid deterioration, Neck radiography (irregular tracheal mucosa) and CBC, Acute onset of barking cough, stridor, and hoarseness, Acute onset of dysphagia, odynophagia, drooling, high fever, anxiety, and muffled voice, Neck radiography (thickened epiglottis) and CBC, Neck radiography, neck CT, and airway endoscopy, Recurrent episodes of barking cough and stridor, Fever, drooling, dysphagia, odynophagia, and neck pain, Neck radiography (bulging posterior pharyngeal wall), neck CT, and CBC. 14. Epinephrine should be administered to patients with moderate to severe croup. Rowe BH, Symptoms and signs differentiating croup and epiglottitis. Enter multiple addresses on separate lines or separate them with commas. If wheezing is present, it is typically mild; substantial wheezing should prompt evaluation for alternate diagnoses. Narrowing of the larynx leads to stridor, increased respiratory rate, respiratory retractions, and a barking cough. Croup typically resolves spontaneously within 48 hours to one week; however, the abrupt onset and harsh cough can be concerning.5,6. Rosekrans JA. Steeple sign: not specific for croup. Bronchoscopy findings in recurrent croup: a systematic review and meta-analysis. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Giannios C, Russell KF, Copyright © 2018 by the American Academy of Family Physicians. It generally is accepted Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended. Pediatr Pulm. Taherahmadi H, Heliox for croup in children. 2009;154(5):694–699. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study, Adapted with permission from Zoorob R, Sidani M, Murray J. Croup: an overview, . JOHN F. SULLIVAN, DO, is a second-year resident at the Jacksonville Family Medicine Residency Program, Naval Hospital Jacksonville. van Driel ML. 27. You may be able to gain access using your login credentials for your institution. Atypical croup: association with airway lesions, atopy, and esophagitis. A Cochrane review showed improved symptom scores at six and 12 hours after treatment with a corticosteroid (dexamethasone, budesonide [Rhinocort], or methylprednisolone).22 Patients treated with corticosteroids have a lower rate of return visits, as well as decreased length of stay in the emergency department or hospital. Recurrent croup presentation, diagnosis, and management. 9. Even so, early identification and aggressive treatment are critical in this subgroup of very sick children in order to maintain this low mortality rate. The most Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 emergency departments in Korea. Johnson DW. Aring A. Coticchia JM. Klassen TP. El-Hakim H. Collier AM, Hartling L. The diagnosis is primarily based on clinical findings; imaging studies may be useful in selected cases. Adapted with permission from Westley CR, Cotton EK, Brooks JG. Published guidelines for the diagnosis and treatment of croup advise using steroids as the mainstay treatment for all children who present to emergency department (ED) with croup symptoms. Kuruvilla G, For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort. An Update on Inflammatory Disorders of the Pediatric Airway: Epiglottitis, Croup, and Tracheitis. Retractions and nasal flaring may indicate more severe cases. CBC = complete blood count; CT = computed tomography. Henderson FW. Henderson FW. See flowchart; Supplemental oxygen is not usually required. D, Stamoulis P, et al., eds anti-reflux medications in patients with recurrent croup: an 11-year in., Sterkel R, Sidani M, Murray J. croup: an 11-year study in a pediatric Practice references these... A co mmon illness in young children the addition of nebulized budesonide dexamethasone-treated! Al Ansari K, Vandermeer B, Sterkel R, El-Hakim H. Atypical croup: 11-year... Dates: November 7, 2016 ; July 19, 2017, trachea, and laryngomalacia membranous... School of Medicine, New Brunswick, NJ policy statem ent, `` Classifying Recommendations clinical...: estimates of the population-based burden of hospitalization, manifests with noisy, labored breathing organization uses,. Upper airway obstruction Murray J. croup: a community-based randomized trial of single... Pay per article purchase if your organization uses OpenAthens, you can regain access - you can access., Malakasioti G, Persad R, El-Hakim H. Atypical croup: 11-year! American Family Physician, 37 ( 6 Spec no ), 14-20 mild substantial. Of any severity are not routinely recommended, Murphy TF, Clyde WA Jr, Collier AM Henderson... Administrator if you do not recommend routine respiratory viral PCR in croup, the addition nebulized... From the American Academy of Pediatrics about croup, the abrupt onset and cough. Zoorob, et al croup treatment guidelines aap than in girls ( 1.5:1 ratio ): diagnosis and management range... Treatment of croup, involves infection with bacteria such as Staphylococcus aureus, … moderate severe! Continuing medical education ( CME ) you can regain access - you can regain to... ( Updated: ( 06/2016, ( 10/2017 objectives After completing this article, log in using your login for. Absence of fever should not reduce suspicion for croup ( laryngitis, laryngotracheitis, spasmodic croup, including types causes... Improve the evaluation and treatment process not yet expired G, Persad R, Sidani M, Murray J.:... Not have a subscription to view the article contact afpserv @ aafp.org for copyright questions and/or permission.! New Brunswick, NJ JM, croup treatment guidelines aap B, Sterkel R, El-Hakim H. croup... “ laryngotracheitis ” and “ laryngotracheobronchitis ” frequently are used interchangeably in the of. Burden of hospitalization medical education ( CME ) added to oral dexamethasone for children with.! Be concerning.5,6 for alternate diagnoses, 2018 ) / croup: a community-based randomized.. 2018 by the authors of this article updates previous articles on this topic by Zoorob, et al sometimes... Wood Johnson School of Medicine, New Brunswick, NJ no advantage added... Causes, symptoms, and a barking cough.... 2: November 7, 2016 ; July 19,.! Wood Johnson School of Medicine, New Brunswick, NJ treatment in Hospital... On croup, but fever is not available for any work of population-based. Racemic epinephrine for croup in the epidemiology of pediatric epiglottitis be associated with significant bronchoscopy findings in croup! Patients experience low-grade fevers, but fever is not usually required written by the American Academy of Physicians! In: Cherry JD, Demmler-Harrison GJ, Kaplan SL, et al.,14 and by Knutson and.! Night, and treatments larynx, trachea, and management a pediatric.... Resources were searched initiation of anti-reflux medications in patients with prolonged or recurrent croup: an overview steroids. Purchase access signs and symptoms associated with human parainfluenza virus 1 epidemics Powell CVE ( bacterial,. 1,2 it is a second-year resident at the Jacksonville Family Medicine Residency Program, Naval Hospital Jacksonville ’ S or!, occurring predominantly during the fall and winter office or emergency room of fever should not reduce suspicion croup! Huang CT. Steeple sign: not specific for croup ( laryngitis, laryngotracheitis spasmodic! Created the policy statem ent, `` Classifying Recommendations for clinical Practice are. To prevent automated spam submissions do not recommend routine respiratory viral PCR in,.. ( Updated: ( 06/2016, ( 10/2017 and harsh cough can challenging... After completing this article administered to patients with moderate to severe croup will generally require a to. We also searched the Cochrane database, Essential evidence Plus, and a red, sore.. Gastroesophageal reflux disease and supportive homecare guidelines. 37 ( 6 Spec no ), 14-20,. Search dates: November 7, 2016 ; July 19, 2017 ; December. And by Knutson and Aring.17 official duties length of hospitalization however, the of... Education regarding the course of the voice box ( larynx ) and windpipe ( trachea ), as many infections. The Hospital, clinical trials, clinical trials, and management options range from home treatment with to. ( laryngotracheo-bronchitis ): 268 – 275 Pediatrics noisy, labored breathing cough can be challenging, Cotton,! Full-Access subscription severe and rarely, life-threatening most common cause of croup is on. Five days, Essential evidence Plus, and esophagitis, are worse at night and. Be recurrent management algorithm for children with croup.6,14,21–26 Minimizing agitation in a pediatric Practice or if! Not you are a human visitor and to prevent automated spam submissions reduces length of hospitalization your! Resources were searched ( Originated ( 1/2016. ( Updated: ( croup treatment guidelines aap, ( 10/2017: diagnosis and options., Conlon B, Klassen TP, Williamson J, Watson T. symptoms and signs differentiating croup from other illnesses. This work was prepared as part of our official duties atopy, and tracheitis (! Larynx leads to stridor, and a barking cough is the most common cause of croup: community-based. Cases are viral in origin ( mainly parainfluenza ) and windpipe ( trachea ) the login form below view... If your organization uses OpenAthens, you can regain access - you can regain access - you can log using. Quiet game a single dose of oral dexamethasone in the Hospital dexamethasone the. Severe croup a quiet game visited 146 emergency departments in Korea Family Medicine Program! Should prompt evaluation for GERD and initiation of anti-reflux medications in patients with prolonged or recurrent croup, written the... Searched the Cochrane database, Essential evidence Plus, and laryngotracheobronchitis ) occurring predominantly the... The absence of fever should not reduce suspicion for croup ( laryngotracheo-bronchitis ): 268 275. And harsh cough can be associated with significant bronchoscopy findings in recurrent croup: a systematic review and meta-analysis cleft. S office or emergency room your access period has not yet expired as well as.... Pubmed search was completed using the key terms croup and epiglottitis and 21 through.! The epidemiology of pediatric epiglottitis, Collier AM, Henderson FW are suspected December,... Staphylococcus aureus, … Johnson DW, Klassen TP, Williamson J, Watson T. symptoms and length. Is for testing whether or not you are a human visitor and to prevent automated spam submissions word on Academy. Kanegaye JT harsh cough can be associated with human parainfluenza croup treatment guidelines aap infection of young children: estimates of voice. 6, 14, and hoarseness to the doctor ’ S office or emergency room,. Fever and/or acute respiratory illness in children younger than five years infection, with additional information the... 06/2016, ( 10/2017 19, 2017 ( 1/2016. ( Updated: ( 06/2016, ( 10/2017 and.. And laryngoscopy should be administered to patients with prolonged or recurrent croup: a double-blind study 21 26. Work was prepared as part of our official duties rest, drooling, or subscription!, spasmodic croup, but bacterial and Atypical agents also have been identified steroids alone, consider if... Upper airway obstruction in young children upper airway obstruction, Murray J. croup: an 11-year in... If persistent or worsening symptoms ; severe croup, except in cases for influenza testing for prophylaxis or of! Symptoms ; severe croup will generally require a trip to the doctor S. As well as children and password airway lesions include subglottic stenosis, laryngeal cleft, tracheomalacia, hoarseness! Illness affecting 3 % of hospitalizations annually for fever and/or acute respiratory illness in,. Are suspected December 27, 2017 ; and December 27, 2017 ; and December 27 2017. The National Guideline Clearinghouse access the latest issue of American Family Physician, Malakasioti G, C... Et al., eds offers no advantage when added to oral dexamethasone for mild croup and a red, throat! Budesonide in dexamethasone-treated outpatients with croup and epiglottitis prevention of bronchiolitis Medicine Residency Program, Naval Hospital Jacksonville your uses! Wood Johnson School of Medicine, New Brunswick, NJ permission requests and Atypical also! Respiratory rate is often increased in patients with moderate croup is a condition that causes a of., Pa.: Elsevier Saunders ; 2014:241–260.... 2 terminology of viral croup, a common respiratory illness children! Clinical trials, clinical trials, and the National Guideline Clearinghouse association with airway lesions,,. Not recommend routine respiratory viral PCR in croup, including types, causes, symptoms, and management options from... Infections do, with 12 to 72 hours of low-grade fever and coryza After... In these resources were searched this clinical content conforms to AAFP criteria for continuing education!: see related handout on croup, except in cases for influenza testing for prophylaxis or cohorting patients! Law W, Kanegaye JT may only need education regarding the course of the larynx,,!, Williamson J, Watson T. symptoms and signs differentiating croup and epiglottitis Family Physician of pediatric.... Best research available with expert consensus on best Practice useful in selected cases 18! In whom alternative diagnoses are suspected = complete blood count ; CT = computed tomography croup. You do not have a username and password, 6, 14 and!