A look at one of the most common and potentially concerning upper respiratory infections in children.


https://media.blubrry.com/coreem/content.blubrry.com/coreem/Croup.mp3



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Tags: Airway, Infectious Diseases, Pediatrics





Show Notes
Background

Croup is a viral infection starts in the nasal and pharyngeal mucosa but spreads to the larynx and trachea

Subglottic narrowing from inflammation
Dynamic obstruction
Barking cough
Inspiratory stridor


Causes:

Parainfluenza virus (most common)
Rhinovirus
Enterovirus
RSV
Rarely: Influenza, Measles


Age range: 6 months to 36 months
Seasonal component with high prevalence in fall and early winter
Differential

Bacterial tracheitis
Acute epiglottitis
Inhaled FB
Retropharyngeal abscess
Anaphylaxis



Presentation & Diagnosis

Classically a prodrome of nonspecific symptoms for 1-3 days with low grade fevers, congestion, runny nose.
Symptoms reach peak severity on the 4th day
“Steeple sign” on Xray (subglottic narrowing) present in only 50% of patients with croup
Assess air entry, skin color, level of consciousness, for tachypnea, if there are retractions / nasal flaring (if present at rest or with agitation) & coughing
“Westley Croup Score” (https://www.mdcalc.com/westley-croup-score)

Chest wall retractions
Stridor
Cyanosis
Level of consciousness
Air entry



Management

Mild Croup

Occasional barking cough,