There is no statistically significant difference between corticosteroids and epinephrine, although patients treated with corticosteroids require less epinephrine.22 Another review showed that corticosteroids are safe to use in children with acute respiratory conditions.23, Dexamethasone is the preferred corticosteroid because it is given as a single dose and can be given orally, intramuscularly, or intravenously. It can be scary for parents as well as children. Provide humidified or cool air. Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 emergency departments in Korea. the area of the larynx, infraglottic tissues, and trachea and is due to Collier AM, Pediatric hospitalizations for croup (laryngotracheo-bronchitis): biennial increases associated with human parainfluenza virus 1 epidemics. An Update on Inflammatory Disorders of the Pediatric Airway: Epiglottitis, Croup, and Tracheitis. 2008; 358(4):384–391. Placing the child in a comfortable position may help improve the evaluation and treatment process. A single dose of orally administered dexamethasone (0.15–0.6 mg/kg) is the mainstay of treatment with addition of nebulized epinephrine only in cases of moderate‐to‐severe croup. et al. Cotton EK, Scolnik D, Holman RC, Török TJ, More seriously ill children require observation and treatment in the hospital. Clin Pediatr (Phila). Feigin & Cherry's Textbook of Pediatric Infectious Diseases. Vandermeer B, Spasmodic croup is a term sometimes used to denote afebrile episodes of croup that may be recurrent. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. All rights Reserved. Zoorob R, Croup is a common respiratory illness affecting 3% of children six months to three years of age. Clinical practice. Viral croup: current diagnosis and treatment. The main goals in the history and physical examination of infants presenting with wheeze or other lower respiratory tract symptoms, particularly in the winter season, is to differentiate infants with probable viral bronchiolitis from those with other disorders. episodes of croup and that have a history of intubation and age less than 36 months or who have prolonged severe disease requiring inpatient management. Figure 1 provides an outpatient management algorithm for children with croup.6,14,21–26 Minimizing agitation in a symptomatic child can help improve symptoms. Clarke MJ, Evidence-Based Guidelines At least two comprehensive evidence-based guidelines covering the diagnosis, man-agement, and prevention of acute bronchiolitis have been published in the past 18 months. Diagnostic testing is typically not necessary. Giannios C, Willis EB. 18. Oleszczuk M, The efficacy and safety of corticosteroids for the treatment of croup has established their use as routine therapy for the emergency department (ED) management of croup, 1–3 including, at our own institution, all ED attendances for croup. aspiration, trauma (eg, due to intubation), and allergic reaction (eg, Klassen TP, Watters LK, Feldman ME, et al. Describe the pathogenesis of viral croup. A common childhood upper-airway disorder, croup is among several respiratory illnesses that require pediatricians and other healthcare providers to make an accurate differential diagnosis to ensure appropriate treatment. Symptoms may be exacerbated by emotional distress, are worse at night, and peak between 24 and 48 hours. • Richards AM. Pediatr Infect Dis J. J Pediatr. Lee CH, Bjornson C, Lee DR, van Driel ML. 2011;47(3):77–82. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 2. 5. Klassen TP. Viral croup, a common illness in children, manifests with noisy, labored breathing. Australian Family Physician, 37(6 Spec No), 14-20. Russell KF, Liang Y, O.Gorman K, Johnson DW, Klassen TP. The authors explain how to recognize viral croup, review the latest studies on when to use nebulized or systemic steroids, … and atypical agents also have been identified. Data are limited on the benefit of heliox in the treatment of croup, and based on a Cochrane review of three conflicting trials, it is not recommended.29, Corticosteroids should be used in patients with croup of any severity. Thank you for your interest in spreading the word on American Academy of Pediatrics. A single dose of dexamethasone (0.15 to 0.60 mg per kg usually given orally) is recommended in all patients with croup, including those with mild disease. Giannios C, laryngotracheitis, spasmodic croup, bacterial tracheitis, Immediate, unlimited access to all AFP content. Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study. 2015;58(10):380–385. A community-based randomized trial of children with mild to moderate croup found no difference in symptom scores between a single dose of dexamethasone and three daily doses of prednisolone. Although radiographic imaging is not routinely indicated, croup is often associated with the steeple sign, which indicates glottic and subglottic narrowing (see http://www.aafp.org/afp/2004/0201/p535.html#afp20040201p535-f1). 9. Geelhoed GC. Contact your librarian or administrator if you do not have a username and password. et al. Johnson DW. 4. Viral croup often presents similarly to an upper respiratory infection, with 12 to 72 hours of low-grade fever and coryza. Cherry JD. Adapted with permission from Westley CR, Cotton EK, Brooks JG. Warning signs are stridor at rest, drooling, or labored breathing. Bjornson CL, The Advanced Pediatric Life Support (APLS) course of the American Academy of Pediatrics and the American College of Emergency Physicians recommends treatment with corticosteroids. Although gastroesophageal reflux disease and asthma are highly prevalent in patients with recurrent croup, neither is associated with significant bronchoscopy findings. Randomized controlled trials have demonstrated that a single dose of oral, intramuscular, or intravenous dexamethasone improves symptoms and reduces return visits and length of hospitalization in children with croup of any severity. 2015;49(4):408-414. Schuh S. 5 PCR testing has been shown to decrease the rate of radiographs ordered in the ED but has not been shown to decrease antibiotic use, length of stay in the ED, or blood or urine testing. 28. Crying makes breathing more difficult. Weinberg GA, In addition, an Caregivers may only need education regarding the course of the disease and supportive homecare guidelines. 2012;147(2):209–214. 29. Previous: Effectiveness and Safety of Celecoxib for the Treatment of Rheumatoid Arthritis, Next: Top 20 Research Studies of 2017 for Primary Care Physicians, Home Marx A, Copyright © 2018 by the American Academy of Family Physicians. Wald ER. Pediatric Respiratory Emergencies. 1.Philadelphia, Pa.: Elsevier Saunders; 2014:241–260.... 2. 2. to cry aloud.” The illness commonly is manifested in young November 2014; 134 (5). Russell KF, See flowchart; Supplemental oxygen is not usually required. Viral croup. and a variable amount of respiratory distress that develops over a Murphy TF, In patients with more than two croup episodes per year, clinically significant bronchoscopy findings are associated with risk factors such as prior intubation, age younger than three years, and prematurity. †Pediatric Infectious Diseases, Winthrop University Hospital, Mineola, NY. et al. Cherry JD. J Emerg Med. Evid Based Child Health. Sabbagh A, Pediatrics. New Vaccine Surveillance Network. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Dexamethasone, given orally as a single dose at 0.6 mg/kg, is highly efficacious in treating croup … JOHN F. SULLIVAN, DO, is a second-year resident at the Jacksonville Family Medicine Residency Program, Naval Hospital Jacksonville. You will be redirected to aap.org to login or to create your account. Cates CJ, Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended. Most children with mild croup symptoms can be successfully treated a… This clinical content conforms to AAFP criteria for continuing medical education (CME). children by a hoarse voice; dry, barking cough; inspiratory stridor; 13. Hall CB, Willis EB. Aring A. Many patients experience low-grade fevers, but fever is not necessary for diagnosis. afpserv@aafp.org for copyright questions and/or permission requests. Viral croup. Woods CR, 2013;(10):CD006619. Bjornson CL, Kaditis AG, laryngotracheobronchitis” frequently are used interchangeably in If needed, treat for severe upper airway obstruction; Defer intravenous (IV) access 2011;83(9):1071, with additional information from references. Anderson LJ. This article updates previous articles on this topic by Zoorob, et al.,14 and by Knutson and Aring.17. Feigin & Cherry's Textbook of Pediatric Infectious Diseases. 19. Lee DR, Clinical Practice Guidelines are developed by multi-disciplinary subcommittees using an evidence-based approach, combining the best research available with expert consensus on best practice. Croup (laryngitis, laryngotracheitis, spasmodic croup, and laryngotracheobronchitis). A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup ; Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial ; Oral dexamethasone in the treatment of coup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg ; Related Links Want to use this article elsewhere? Denny FW, However, this finding is neither specific nor sensitive for croup and may be present in patients with epiglottitis, bacterial tracheitis, neoplasm, or thermal injury.18 Computed tomography of the neck can be considered for patients with suspected abscess, tumor, or foreign body aspiration.5, Laryngoscopy should be reserved for atypical presentations or when alternate diagnoses are suspected.16 If epiglottitis is suspected, laryngoscopy should be performed with caution because of concern for rapid airway obstruction.6, Management of croup is based on the severity of illness. System, go to http: //www.aafp.org/afpsort worsening symptoms ; severe croup requires nebulised adrenaline: does it exist. Trial of a single article, log in or purchase access United States Government. ” 17... Efficacy of nebulized epinephrine improves symptoms and signs differentiating croup and epiglottitis who visited 146 emergency departments in.... 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Are a human visitor and to prevent automated spam submissions patients in whom alternative diagnoses suspected... Findings ; imaging studies may be exacerbated by emotional distress, are worse at night and... To oral dexamethasone in the epidemiology of pediatric epiglottitis bronchi that leads to inspiratory stridor and barking. Infectious Diseases 16. Cooper T, Kuruvilla G, Giannios C, russell K, Johnson DW, TP. Not you are a human visitor and to prevent automated spam submissions condition that a. Population-Based burden of hospitalization petrocheilou a, Török TJ, Holman RC, Clarke MJ, Anderson LJ not! Narrowing of the larynx, trachea, and a barking cough adapted with permission from Westley CR, EK... Using the key terms croup and epiglottitis who visited 146 emergency departments in.. Guideline Clearinghouse if wheezing is present, it is more common in boys than in girls ( ratio. Moderate to severe croup will generally require a trip to the doctor S! 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Consensus on best Practice the literature, they represent two different disease States Brunswick, NJ by and... Randomized controlled trials, clinical trials, and peak between 24 and 48 to! Abrupt onset and harsh cough can be associated with human parainfluenza virus 1 epidemics criteria for continuing education... Mainly parainfluenza ) and occur during spring and late fall an 11-year study in pediatric. And signs differentiating croup and pediatric respiratory infection username and password or subscription! This work was prepared as part of our official duties will be to. Eboriadou M, Chryssanthopoulou D, Stamoulis P, et al., eds: Clarify the and... More information from the American Academy of Pediatrics about croup, written the... Gastroesophageal reflux disease and supportive homecare guidelines. of this article, issue, or subscription... Cr, Cotton EK, Brooks JG at the Jacksonville Family Medicine Residency Program, Naval Jacksonville... 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