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

Treatment

All patients with croup who have signs of breathing difficulty should receive systemic steroids. Dexamethasone solution 150 micrograms/kg PO is the first line. If this is unavailable, then soluble prednisolone tablets 1-2mg/kg may be used.

Secondary care management

See local acute trust guidance for the inpatient assessment and management of croup.