Assessment and admission
- Immediately admit a child who has moderate or severe croup, or impending respiratory failure.
- Most children will have mild croup, which can be managed at home. However, consider admission to hospital if any of the following are present. The child:
- Has a history of severe obstruction, or previous severe croup, or known structural upper airways abnormalities (e.g. laryngomalacia, tracheomalacia, vascular ring, Down's syndrome); these increase the risk of severe croup developing.
- Is less than 6 months of age.
- Is immunocompromised.
- Has inadequate fluid intake, or is refusing liquids.
- Has a poor response to initial treatment.
- Has an uncertain diagnosis.
- Or if there is significant parental anxiety, late evening or night-time presentation, the child's home is a long way from the hospital, or the parents have no transport.
All patients with croup who have signs of breathing difficulty should receive systemic steroids.
Oral dexamethasone solution 150 micrograms/ kg is the first line. If this is unavailable, then oral prednisolone 1-2mg/ kg may be used.
Secondary care management
See local acute trust guidance for the inpatient assessment and management of croup.
North Devon District Hospital guidance (N3 connection required)
3. Respiratory >
Guidance on croup
- First line
- Second line