Croup is a clinical presentation involving barking cough, with or without stridor and respiratory distress. This usually occurs in a relatively well child, though they will have the symptoms of a viral upper respiratory tract infection. Like so many presentations in childhood, the underlying cause is a viral illness but the problem is due to the effect or response to the virus. In the case of croup, that effect is upper airway inflammation and swelling.
When should croup be treated?
Croup is usually classified into mild, moderate or severe. This can be done with or without a croup score. While it is a minor oversimplification of what happens next, the likelihood is that severe croup will be treated with steroids and often admitted to hospital while moderate croup will usually be treated with steroids and discharged home after a period of observation.
It is the management of mild croup which often generates the most discussion. The first question is whether it should be treated at all. There is evidence that treating mild croup with corticosteroids reduces symptoms. (1) There is the suggestion that it is safer to treat mild croup in that there is a reduction in time spent in hospital and reduced readmission rate for those that are treated. However, there is no specific evidence that not treating mild croup leads to an increased risk of severe or life-threatening croup. This leads some clinicians to the conclusion that if a child has a barking cough but no stridor or respiratory distress, they prefer to provide safety-netting advice and reassess if the child develops new signs.