Synopsis
Recognise the barking-cough syndrome, grade upper-airway obstruction while keeping the child calm, give early corticosteroid and nebulised adrenaline when indicated, and distinguish croup from epiglottitis, bacterial tracheitis, anaphylaxis and an inhaled foreign body.
- Croup is viral subglottic inflammation, usually between 6 months and 6 years, causing a seal-like barking cough, hoarse voice and inspiratory stridor, often worse at night.
- Assess before touching: position, mental state, stridor at rest, recession, air entry, colour and hydration. Agitation worsens dynamic obstruction, so keep the child on the caregiver's lap.
- Mild croup has barking cough without stridor or recession at rest. Moderate disease has stridor and/or recession at rest without agitation or lethargy. Severe disease adds marked distress, agitation or lethargy.
Key red flags
Cyanosis, reduced consciousness, exhaustion, poor effort or reduced air entry indicates impending respiratory arrest even if stridor becomes quieter.
Investigation priorities
Diagnose typical croup and detect impending failure without worsening obstruction.
Management branches
Barking cough is present without stridor or recession at rest.
- Give oral dexamethasone 0.15 mg/kg once using the local product maximum.
- Confirm safe drinking and no feature of a dangerous alternative.
Key medicines
DexamethasoneChild with croup: 0.15 mg/kg orally as a single dose; use the age-appropriate preparation and local product maximum. If oral treatment is not feasible, follow the local parenteral or nebulised-budesonide pathway.
Adrenaline 1 mg/mL nebulisedSevere or worsening croup: 400 micrograms/kg, equivalent to 0.4 mL/kg of 1 mg/mL solution, maximum 5 mg or 5 mL, by nebuliser; repeat only with senior review and continuous monitoring.