Pediatric Coughs: Croup
Valeria Wu, MD
Presentation: commonly children 6 months to 3 years old, URI and develops into barking cough/hoarseness worse at night
Usually viral, though can be bacterial
Diagnosis: Clinical. If you get a chest x-ray, can see subglottic narrowing “steeples sign”
Treatment: dexamethasone: 0.6 mg/kg PO or prednisolone 1 mg/kg PO
stridor at rest > nebulized epinephrine & observe for at least 3 - 4 hours, repeat as needed
Repeated epinephrine treatments = admission
Severe: consider intubation (go with smaller tube, airways may be edematous)
Take note: Remember to keep your differential broad!
Epiglottitis (rare) - respiratory distress, tripoding, less likely to have cough, will have stridor and respiratory distress
Bacterial tracheitis - stridor as well, productive cough, kid will look sicker, tender trachea/throat
Foreign body - sudden onset, always have a suspicion for this
Freire G, Shefrin A, Zemek R. Wheezing in Infants and Children. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill; Accessed October 29, 2020.