Print. Kuruvilla G, 24. 2016;90:86–90. Croup in children. Won YK, Viral croup: current diagnosis and treatment. Marx A, Cochrane Database Syst Rev. 3,4 Illness is typically mild and self-limiting but can be severe and rarely, life-threatening. an infectious agent. Bagheri B, Moraa I, Clyde WA Jr, https://www.youtube.com/watch?v=RXJxtAHtkcs, http://www.aafp.org/afp/2004/0201/p535.html#afp20040201p535-f1, Effectiveness and Safety of Celecoxib for the Treatment of Rheumatoid Arthritis, Top 20 Research Studies of 2017 for Primary Care Physicians. Clarke MJ, 2014;49(5):421–429. 5. Sidani 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. et al. Marx A, the literature, they represent two different disease states. Pediatric hospitalizations for croup (laryngotracheo-bronchitis): biennial increases associated with human parainfluenza virus 1 epidemics. 2014;9(3):733–747. that acute laryngotracheitis and spasmodic croup are caused by viral 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. 2011;83(9):1067–1073. Pediatr Emerg Care 2005; 21:359. Symptoms and signs differentiating croup and epiglottitis. Bjornson CL, 23. Kwong K, Previous: Effectiveness and Safety of Celecoxib for the Treatment of Rheumatoid Arthritis, Next: Top 20 Research Studies of 2017 for Primary Care Physicians, Home Fernandes RM, Stroud RH , Friedman NR . 2014;2014. Brooks JG. Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended. Johnson DW, Mayo Clin Proc. *Division of Pediatric Infectious Diseases, UMDNJ-Robert Wood Johnson School of Medicine, New Brunswick, NJ. JOHN F. SULLIVAN, DO, is a second-year resident at the Jacksonville Family Medicine Residency Program, Naval Hospital Jacksonville. Even so, early identification and aggressive treatment are critical in this subgroup of very sick children in order to maintain this low mortality rate. Clin Pediatr (Phila). and atypical agents also have been identified. Hartling L. CBC = complete blood count; CT = computed tomography. Conlon B, Russell KF, 2012;43(5):e333–e334. Pediatric Emergency Research Canada Network. children by a hoarse voice; dry, barking cough; inspiratory stridor; Am J Otolaryngol. Glucocorticoids for croup. Am Fam Physician. Cotton EK, 25. Cherry JD. The danger of croup is that the airway can become so narrow that breathing becomes labored or impossible. Eghbali A, Hiebert JC, Among the noninfectious etiologies of this syndrome are foreign body responsible for causing disease further down the respiratory tract, Int J Pediatr Otorhinolaryngol. Spasmodic croup is a term sometimes used to denote afebrile episodes of croup that may be recurrent. Huang CT. Kaditis AG. Clarify the definition and terminology of viral croup. 101 defines United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties. In patients with moderate to severe croup, the addition of nebulized epinephrine improves symptoms and reduces length of hospitalization. See the CME Quiz Questions. Johnson DW. The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: an overview of reviews. • Richards AM. Moore M, Taherahmadi H, Henderson FW. Croup (Acute Laryngotracheobronchitis) Definition / Supporting Information Viral croup (acute laryngotracheobronchitis) is an age-specific viral syndrome characterised by acute laryngeal and subglottic swelling, resulting in: • Hoarseness • Cough • Respiratory distress (see Dyspnoea) • … Urgent care or emergency department treatment of croup depends on the patient's degree of respiratory distress. 4. 2009;154(5):694–699. Enlarge Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study. Tanou K, Eghbali A,      Print. Malakasioti G, Radiography and laryngoscopy should be reserved for patients in whom alternative diagnoses are suspected. 97/No. Clinical practice. Recurrent croup presentation, diagnosis, and management. Oleszczuk M, Adapted with permission from Westley CR, Cotton EK, Brooks JG. Won YK, Humidified air inhalation does not improve symptoms in patients with moderate croup. Differentiating croup from other acute illnesses can be challenging. the area of the larynx, infraglottic tissues, and trachea and is due to Symptoms may be exacerbated by emotional distress, are worse at night, and peak between 24 and 48 hours. Persad R, This content is owned by the AAFP. Kalampouka E, Although there's no evidence of benefit from these practices, many parents believe that humid air or cool air helps a child's breathing. 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 DUSTIN K. SMITH, DO, is an assistant program director at the Jacksonville Family Medicine Residency Program, Naval Hospital Jacksonville (Fla.).... ANDREW J. MCDERMOTT, MD, is a faculty member at the Jacksonville Family Medicine Residency Program, Naval Hospital Jacksonville. Murphy TF, Török TJ, Oxygen should be administered to children with hypoxemia or severe respiratory distress. 1. Search dates: November 7, 2016; July 19, 2017; and December 27, 2017. Cates CJ, 1997;176(6):1423–1427. • Petrocheilou A, et al. Croup: an overview. Nebulized epinephrine for croup in children. Title 17 U.S.C. Cochrane Database Syst Rev. Scolnik D, 7th ed., vol. 2008; 358(4):384–391. 1998;73(11):1102–1106. Immediate, unlimited access to all AFP content. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Liang Y, Sturman N, Patient information: See related handout on croup, written by the authors of this article. Oleszczuk M, Parainfluenza viruses are the most common cause of croup; however, other causes including epiglottitis and bacterial tracheitis should be considered in the differential diagnosis. Viral croup: diagnosis and a treatment algorithm. Tanou K, Crying makes breathing more difficult. Anderson LJ. Bjornson CL, 2. In addition, an 2. The lung parenchyma is involved occasionally. Am Fam Physician. Croup. Choose a single article, issue, or full-access subscription. Anderson LJ. Symptoms and signs differentiating croup and epiglottitis. Most children with mild croup symptoms can be successfully treated a… Contact your librarian or administrator if you do not have a username and password. Croup typically resolves spontaneously within 48 hours to one week; however, the abrupt onset and harsh cough can be concerning.5,6. An Update on Inflammatory Disorders of the Pediatric Airway: Epiglottitis, Croup, and Tracheitis. Consider evaluation and treatment for allergies Give Dexamethasone New Vaccine Surveillance Network. Russell K, Pediatrics. 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. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. Faden H. Croup: an overview. 1978;132(5):484–487. November 2014; 134 (5). Viral croup: diagnosis and a treatment algorithm. 2013;185(15):1317–1323. This article updates previous articles on this topic by Zoorob, et al.,14 and by Knutson and Aring.17. Treatment with dexamethasone results in faster resolution of symptoms and decreased return to medical care.21 Corticosteroids are thought to work by decreasing laryngeal mucosal edema through their anti-inflammatory effects. Cotton EK, Although humidified air inhalation has been historically used for management of croup, a meta-analysis of three studies (N = 125) found no statistically significant effect on croup scores or hospital admission in patients with moderate croup.27 Treatment with specifically designed humidity droplets that deposit in the larynx is no better than controlled delivery of 40% humidity or humidity via blow-by administration.28, Heliox is a helium and oxygen mixture used for respiratory conditions that theoretically improves airflow resistance by decreasing gas density (helium is a low-density gas). Johnson DW. Sterkel R, ; 11 For severe croup, the APLS advocates racemic or L-epinephrine, followed by observation for 3 or 4 hours and hospital admission in the event of inadequate response or recurrence of severe distress. If wheezing is present, it is typically mild; substantial wheezing should prompt evaluation for alternate diagnoses. Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 emergency departments in Korea. Rhonchi may be present but are not typical. Croup is a common respiratory illness affecting 3% of children six months to three years of age. We also searched the Cochrane database, Essential Evidence Plus, and the National Guideline Clearinghouse. Read on for more information from the American Academy of Pediatrics about croup, including types, causes, symptoms, and treatments. Bjornson CL, 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. Garbutt JM, Woods CR, Respiratory rate is often increased in patients with croup. 15. Viral croup: current diagnosis and treatment. El-Hakim H. ; 1998;17(9):827–834. Enlarge Viral croup often presents similarly to an upper respiratory infection, with 12 to 72 hours of low-grade fever and coryza. Croup. acute angioneurotic edema). Am Fam Physician. The effects of epinephrine wane after one to two hours, so patients should be monitored for at least two hours after administration before they are discharged.6,25 Although adverse effects of nebulized epinephrine are rare, patients receiving frequent treatments should be monitored for adverse cardiac effects. 2013;(10):CD006619. 21. Adapted with permission from Westley CR, Cotton EK, Brooks JG. Most children with croup have mild and short-lived symptoms, with <1% of cases experiencing severe symptoms . 1.Philadelphia, Pa.: Elsevier Saunders; 2014:241–260.... 2. Parainfluenza virus infection of young children: estimates of the population-based burden of hospitalization. Klassen TP. Sterkel R, In: Cherry JD, Demmler-Harrison GJ, Kaplan SL, et al., eds. Atypical croup: association with airway lesions, atopy, and esophagitis. Klassen TP. Conlon B, †Pediatric Infectious Diseases, Winthrop University Hospital, Mineola, NY. 2. laryngotracheobronchitis, and laryngotracheobronchopneumonitis. Diagnostic testing is typically not necessary. Disease, and peak between 24 and 48 hours to one week ;,! Of pediatric epiglottitis a co mmon illness in young children croup and epiglottitis visited... Oxygen is not usually required Saunders ; 2014:241–260.... 2 from references 2,,. © 2018 by the American Academy of Pediatrics accounts for 7 % of hospitalizations annually for and/or! Length of hospitalization infections do, with additional information from the American Academy of Pediatrics about croup including... A trip to the doctor ’ S office or emergency room to AAFP criteria for continuing medical education ( ). Have a subscription to view the full text RC, Clarke MJ, Anderson LJ treatment the... 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