CMT05103: Paediatrics and
Child Health I
Session 24: Croup
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Learning tasks
At the end of this session, students are expected to be
able to:
• Define the term croup
• Describe the epidemiology and risk factors/ causes
• Describe the pathophysiology
• Explain the clinical features
• Describe investigations and differential diagnosis
• Explain complications
• Manage and prevent croup
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Activity: Brainstorming
• What is croup?
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Definition of Croup
• Croup is a common primarily pediatric viral
respiratory tract illness
• Its alternative names, laryngotracheitis and
laryngotracheobronchitis
4
Epidemiology
• Croup is the most common pediatric illness that
causes acute stridor, accounting for approximately
15% of annual clinic and emergency department
visits for pediatric respiratory tract infections.
• Croup is primarily a disease of infants and
toddlers, with an age peak incidence of age 6
months to 36 months (3 years).
• The male-to-female ratio for croup is
approximately 1.4:1.
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Risk factors
• Most at risk of getting croup are children
between 6 months and 3 years of age.
• Because children have small airways, they are
most susceptible to having more symptoms
with croup.
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Causes
• Parainfluenza viruses (types 1, 2, 3) are
responsible for as many as 80% of croup cases
• Type 3 parainfluenza virus causes bronchiolitis
and pneumonia in young infants and children
• Parainfluenza types 1 and 2, accounting for
nearly 66% of cases.
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Causes, cont..
Other infectious causes of croup
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The pathophysiology
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The clinical features
• Croup usually begins with nonspecific respiratory
symptoms (i.e., rhinorrhea, sore throat, cough).
• Within 1-2 days, the characteristic signs of
hoarseness, barking cough, and inspiratory stridor
develop, often suddenly, along with a variable
degree of respiratory distress.
• Fever is generally low grade (38-39°C) but can
exceed 40°C.
• Symptoms typically resolve within 3-7 days but can
last as long as 2 weeks.
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Complications
• Complications in croup are rare
• Death occurred in approximately 0.5% of
intubated patients.
• Less than 5% of children who were diagnosed
with croup required hospitalization .
• Less than 2% of those who were hospitalized
were intubated.
• A secondary bacterial infection may result in
pneumonia or bacterial tracheitis
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Complications, cont..
• Other complications:
o Pulmonary edema
o Pneumothorax
o Pneumomediastinum
o Lymphadenitis
o Otitis media
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Differential diagnosis
• Airway Foreign Body Bacterial Tracheitis
• Diphtheria
• Epiglottitis
• Inhalation Injury
• Laryngeal Fractures
• Laryngomalacia
• Measles
• Mononucleosis and Epstein-Barr Virus Infection
• Peritonsillar Abscess
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Investigations
• Croup is primarily a clinical diagnosis, with the diagnostic
clues based on presenting history and physical examination
findings.
• Laboratory test results rarely contribute to confirming this
diagnosis.
• The complete blood cell (CBC) count is usually nonspecific
• Pulse oximetry is helpful to assess for the need for
supplemental oxygen support and to monitor for worsening
respiratory.
• Arterial blood gas (ABG) measurements are unnecessary and
do not reveal hypoxia or hypercarbia unless respiratory fatigue
ensues
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Investigations, cont..
Radiography
• Plain films can verify a presumptive diagnosis or exclude other disorders
causing stridor and hence mimic croup.
• Steeple or pencil sign of the proximal trachea evident on this
anteroposterior film.
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Treatment
• Urgent care or emergency department treatment
of croup depends on the degree of respiratory
distress
• Keep young children as comfortable as possible
• Careful monitoring of ;
o Heart rate
o Respiratory rate
o Respiratory mechanics
o Pulse oximetry
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Treatment, cont..
• Those with severe respiratory distress or compromise
may require 100% oxygenation with ventilation
support, initially with a bagvalve- mask device
• Steroids have proven beneficial in severe, moderate,
and even mild croup
• In the straightforward cases of croup, antibiotics are
not prescribed, as the primary cause is viral.
• A single dose of dexamethasone is effective in
reducing the overall severity of croup, if administered
within the first 4-24 hours after the onset of illness.
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Preventive measures
• To prevent croup, take the same steps you use
to prevent colds and flu.
o Frequent hand-washing is the most important.
o Keep your child away from anyone who's sick.
o Encourage your child to cough or sneeze into his
or her elbow.
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Key points
• Most at risk of getting croup are children between
6 months and 3 years of age
• Croup is primarily a clinical diagnosis, with the
diagnostic clues based on presenting history and
physical examination findings.
• Urgent care or emergency department treatment of
croup depends on the degree of respiratory distress
19
Review questions
• What is croup?
• What are the signs and symptoms of croup?
• What is the etiology of croup?
• How is croup diagnosed?
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References
• WHO (2013). Hospital Care for Children: Guideline for the
Management of Common Childhood Illnesses, 2 nd Edition.
• Stanfield, P. et al, (2005), Child Health: A manual for Medical and
Health Workers in Health Centres and Rural Hospitals, 3 rd ed,
AMREF, Nairobi. Kenya.
• MoHCDGEC (2017). Standard Treatment Guidelines and National
Essential Medicines List: Tanzania Mainland (4 th Ed).
• MoHCDGEC, (2019). National Guideline for Neonatal Care and
Establishment of Neonatal Care Unit, RCH Section, Dodoma
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References, cont..
• WHO (2003). Managing Newborn Problems:
A guide for doctors, nurses, and midwives.
Department of Reproduction Health and
Research, World Health Organization, Geneva.
• MoHCDGEC (2018). Standard Treatment
Guidelines and National Essential Medicines
List: For Children and Adolescents (1st Ed).
Dodoma.
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