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The Management of Croup in the Emergency Room

Taken from a presentation at the
Continuing Professional Learning conference:"POGO 2005"
February 3 - 5, 2005
Dr. Vicki Cattell, MD, CRCP(C)


Three precent of children under six years of age.


Mostly entirely Viral. There is usually no role for antibiotics in management.


In older children the causative organism may be Mycoplasma, which can be identified as a nasopharyngeal swab.



Chest x-ray can be useful to exclude a foreign body if the history raises suspicion of this, and to exclude other etiology in an older, toxic child.

Blood work is generally non-contributory if croup is evident on clinical grounds.


The aim of croup management is to minimize turbulent air flow through the upper respiratory tract.

Mild to Moderate Croup

Decadron 0.6mg/kg in one dose to a maximum of 8.0 mg (or pediapred 1 mg/kg). This is given to all children with croup.

There is no advantage to giving more than one dose of either.

There is no advantage to giving pulmicort inhalation in place of or in addition to decadron.

JAMA, May 27 1998 Vol 279 "The clinical outcome of mild to moderate croup patients is as good after treatment with oral dexamethasone as it is after nebulized budesonide alone or after a combination of budesonide and dexamethasone."

Severe Croup

Suggested by:

Find position of comfort the child.

Bring down temperature, using rectal suppository, if necessary.

"Rescue" with nebulized epinephrine:

Key Point

Consider alternative to croup if the child presents with:

Differential diagnosis: bacterial tracheitis or epiglottitis.

When to Refer