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

^#CROUP SCORING

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