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- Croup (laryngotracheobronchitis) is a common childhood disease that is usually caused by a virus.

- It is characterized by the sudden onset of a seal-like barking cough usually accompanied by stridor (predominantly inspiratory), hoarse voice, and respiratory distress due to upper-airway obstruction.

-The symptoms are a result of upper-airway obstruction due to generalised inflammation of the airways, as a result of viral infection (typically parainfluenza virus types 1 or 3).

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- Seal-like barking cough but no stridor, or no sternal/intercostal recession at rest
- Symptoms are usually worse at night

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- Seal-like barking cough with stridor and sternal recession at rest, however no agitation or lethargy

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- Severe croup symptoms include a seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy

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- Abnormal Chest Wall movement
- Cyanosis
- Decreased levels of conciousness
- Tracheal Tug
- Fatigue
- Nasal Flaring
- Low SpO2 Readings
- Increased respiratory rate
- Decreased air entry & Stridor on auscultation
- Mottling
- Persistent Agitation

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Stridor Lung Sounds Animation - EMTprep.com

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- Croup most commonly affects children between 6 months and 6 years of age
- Peak incidence of croup occurs during the second year of life
- Croup can be seen in infants as young as 3 months of age, and also occurs (although rarely) in older children, adolescents, and adults
- Male sex - more boys are affected with a male to female ratio of 1.4 to 1
- Previous intubation - a small study has suggested this increases the risk, but the evidence is considered to be weak
- Risk of croup reduces with older age as the airways develop

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Used to assist clinicians in decsision making

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- Paracetamol & Ibuprofen - to control fever & pain

- Dexamethasone - Administration orally, Initial dose 1 - 12months of age 1.9miligrams in 0.5ml.  18months-6 years 3.87 milligrams in 1ml

- Dexamethasone is NOT carried by WMAS, therefore in most moderate + severe cases, patients should be transported to the nearest receiving paediatric emergency department

- Croup is usually self-limiting and symptoms usually resolve within 48 hours. If the child is being managed at home, the use of paracetamol or ibuprofen to control fever and pain should be advised, and parents should be advised to seek urgent medical advice if there is any deterioration.

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- Good Hygiene
- Good environmental conditions (avoiding damp, steamy areas)
- Clean surfaces, toys, etc
- Washing hands, Covering mouth when coughing etc

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- There is often a preceding 12 - 48 hour history of an non-specific cough, rhinorrhoea, and fever.
- There may be a fever
- Cold-like symptoms
- Croup symptoms will usually follow, often worse at night