Croup- How to Manage?

Use The The Croup Clinical Score# to Classify Croup as Mild, Moderate or Severe..

  • Mild and moderate croup 
    • They can be treated as out patient 
    • Mist Therapy(Saline Nebulisations) can be given, Steam use should be discouraged because of risk of burns.
    • Single dose of Oral Dexamethasone (0.6mg/kg- Max 16 mg) / Prednisolone (1mg/kg). In case Prednisolone is used, it may be continued for 3 days (2mg/k/day in divided doses).
    • Explain to review again in case of danger signs*
  • Severe croup
    • Needs Hospitalisation
    • Humidified Oxygen
    • Oral or IM or IV Dexamethasone (0.6mg/kg, Max 16 mg)**
    • Nebulisation with Adrenaline 1:1000, (0.5ml/kg, Add saline if total volume in nebuliser chamber is less then 3 ml, Max dose of adrenaline is 5 ml)
    • IV fluids if oral intake poor

General Principles

  • Antibiotics are of no help
  • Antiallergics should not be given- They make the secretions viscid and do more harm than good
  • Child should be kept well hydrated all the times

*Danger signs – to be explained to parents

  • Makes a noisy, high-pitched breathing sound (doctors call it “stridor”) when child breathes in or out
  • Starts drooling or has a hard time swallowing
  • Is anxious, agitated, or has no energy
  • Breathes much faster than usual
  • Has a hard time breathing (chest muscles pull in, पसली चलना)
  • Turns gray or blue around her nose, mouth, or fingernails
  • Seems to be dehydrated, with dry lips or tongue, and/or no urine output

**Dexamethasone can be given IM, IV, or orally and should generally be administered via the least invasive route possible. 

**The oral liquid preparation of dexamethasone (1 mg per mL) has a foul taste. The IV preparation is more concentrated (4 mg per mL) and can be given orally mixed with syrup 


Clinical Feature Degree – Score
Stridor None – 0
At rest on auscultation 1
At rest without auscultation 2
Recessions None – 0
Mild 1
Moderate 2
Severe 3
Cyanosis None – 0
With agitation 4
At rest 5
Consciousness level Normal – 0
Altered 5


  • 0-2       =          Mild Croup
  • 3-5       =          Moderate Croup
  • 6-11     =          Severe croup

PREVIOUS POSTS: Mist in Croup Epinephrine in Croup

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