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    Diagnosis and management of croup in children

    Although most cases of croup in children resolve on their own, it is important that pediatricians be able to differentiate between symptoms of croup and other acute respiratory diseases to ensure proper treatment.

    Vaccine Wars logoA 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. It occurs most commonly in children aged between 6 months and 3 years and during the late autumn months, but sporadic cases can also occur any time of year and in older children.1,2

    Recommended: 'Red flags' for chronic cough

    Although most cases of croup resolve on their own, children with even mild disease are now routinely treated with corticosteroids and those with more moderate to severe disease with immediate nebulized adrenaline.2,3 Very few children require hospitalization, with only about 1% to 8% of children needing hospitalization.2,3 Despite this, most children with symptoms of croup who present to the emergency department (ED) have only mild disease that does not require hospitalization.2,3

    Table 1 - Conditions to consider in making the differential diagnosis of croup

    This article provides pediatricians and other pediatric healthcare providers with quick reference to the diagnosis and management of croup. The goal is to help pediatricians accurately diagnose and treat these children as well as educate their parents on the symptoms of the illness to help them know when to call their physician or when a visit to the ED is warranted.

    Etiology and diagnosis

    Symptoms of croup can be similar to other respiratory diseases, so making the differential diagnosis is important to both treat appropriately and avoid unnecessary treatment. Most cases of croup are from a viral infection (called laryngotracheitis) or are spasmodic (called recurrent croup), although other conditions can mimic the symptoms of croup and need to be considered in making the differential diagnosis (Table 1).2

    Table 2 - How to distinguish croup from recurrent croup

    This article will focus on the diagnosis and treatment of croup, however pediatricians should be aware of recurrent croup and the potential for an underlying condition that may be masked by the persistence of croup symptoms (Table 2).4 For children with symptoms of recurrent croup, referral to an otolaryngologist is advised.

    NEXT: Further ways to diagnose croup

    Mary Beth Nierengarten, MA
    Mary Beth Nierengarten is a freelance medical writer with over 25 years of experience. Her work appears regularly in a number of print ...


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