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Croup, or laryngotracheobronchitis, is a common respiratory infection affecting children from 6 months to 3 years of age (peak incidence, 2 years). The most important concern of the emergency physician is to distinguish between croup, which is typically viral in origin and self-limited, and epiglottitis, which is generally bacterial in origin, requires antibiotic treatment, and more often leads to airway compromise. Croup results from glottic and subglottic mucosal edema and is associated with a characteristic "barking seal" cough. Bacterial tracheitis is a rare, very serious infection that may produce a cough similar to that produced by croup. Patients are acutely ill and require intravenous antibiotic therapy with close airway monitoring in an ICU setting.


  • The main cause of croup is viral croup. Other possible causes such as including bacteria, allergies, and inhaled irritants. Acid reflux from the stomach may also trigger croup.
  • Mostly the croup is caused by parainfluenza viruses, and other RSV, measles, adenovirus, and influenza may also cause croup.


  • Gradually increasing URI symptoms, mild fever, and nonproductive cough over 2 to 3 days
  • Symptoms worse at night
  • Paroxysmal, "barking" cough often accompanied by inspiratory stridor and dyspnea (predominant symptom)
  • Symptomatic improvement with exposure to cool, damp air

"Spasmodic" croup variant

  • Abrupt onset without antecedent URI symptoms
  • Year-round incidence
  • Possibly a result of airway hyperreactivity caused by viruses, allergens, or possible genetic predispositions


  • Barking cough
  • Inspiratory stridor
  • Hoarseness
  • Signs of respiratory distress vary depending on degree of obstruction and include tachypnea, intercostal and suprasternal retractions, tachycardia, nasal flaring, and cyanosis.


  • For the treatment of croup, Aerosolized racemic epinephrine as well as oral dexamethasone are used to help to shrink the upper airway swelling. You can also used antibiotic therapy to treat bacterial infection.
  • If symptoms of your child's worse, then his or her doctor may prescribe medication such as includes corticosteroids, epinephrine or another medication to open the airways.
  • If you have cool mist humidifier, let your child breathe directly in front of the stream of mist. When the child improves, then keep the mist flowing near the bed for the rest of the night and If you have a hot mist vaporizer, then you can use it but don't get too close, as child can get burned.

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