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6 mths to 6 yrs, occasionally older, peak incidence 1–2 yrs
Loud inspiratory (increased if upset) harsh brassy cough
Viral cause—mostly parainfluenza 1, also RSV
Prodrome of URTI or coryza for 2 d
Fever variable—rarely above 39°C
Usually self-limiting
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Barking cough, no or minimal stridor at rest, mild chest retraction, hoarse voice, no distress:
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manage at home by keeping the child as calm as possible
avoid steaming measures but humid atmosphere helpful
consider oral steroids (e.g. prednisolone oral liquid 0.15–0.3 mg/kg/dose) if stridor and chest wall retraction develop
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Inspiratory stridor at rest with sternal and chest wall retraction:
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admit to hospital (e.g. emergency department)
cool humidified air
single dose oral steroids: dexamethasone 0.15 mg/kg or
nebulised adrenaline—if poor response to steroids
observe for at least 4 hrs; discharge when stridor-free at rest
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Severe croup (marked respiratory distress with use of accessory muscles, patient restless and agitated, pallor, cyanosis, tachycardia and exhaustion, i.e. impending airway obstruction):
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nurse in intensive care
oxygen
adrenaline is first-line therapy:
– nebulised adrenaline 0.1% 1:1000 solution 0.5 mL/kg/dose (to max. 5 mL) (beware possible rebound effect after 2–3 hrs—child must be observed)
Note: Can use 4–5 ampoules of 1:1000 solution in a nebuliser run with O2 8 L/min. Repeat dose if no response in 30 mins.
plus
dexamethasone 0.2 mg/kg (o) or IM or IV (if vomiting) as a single dose, followed by other steroids: prednisolone 1 mg/kg as a single dose or budesonide 2 mg by inhalation via nebuliser
have facilities for artificial airway
may need endotracheal intubation for 48 hrs
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There is no place for cough medicine or antibiotics.
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INDICATIONS FOR STEROIDS IN CROUP
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Stridor
Respiratory distress
Age <2 yrs
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