Guidance on croup

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)


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