-          Ages 6 months – 3 years

-          Parainfluenza virus

-          Peak Fall/Early winter

Signs/symptoms: 

-          URI prodrome

-          Barking cough, hoarse voice

-          Symptoms most severe on 3^rd-4^th day -  can develop varying degrees of airway obstruction over 12-48h

-          Inspiratory stridor

-          Epiglottitis

-          Tracheitis

-          Retropharyngeal abscess

-          Foreign body aspiration

-          Allergic reaction

-          Rare: diphtheria; < 6 mos consider vascular slings/rings, airway hemangioma, laryngomalacia, subglottic stenosis, vocal cord paralysis

Classification:

-          Mild – no stridor at rest, +/- stridor and mild retractions when agitated

-          Moderate – stridor at rest + mild retractions, little to no signs of agitation or distress

-          Severe – stridor at rest + severe retractions, agitation and signs of respiratory distress

-          Impending respiratory failure – decreased breath sounds, altered mental status, inspiratory and expiratory stridor, cyanosis

Diagnostic Studies:

-          ***Clinical diagnosis***

-          Classic finding of PA Neck XR with “Steeple Sign” due to subglottic narrowing due to edema

Management:

Options include steroids, nebulized racemic epinephrine, and respiratory support

-          Mild – 1x dose dexamethasone (IM or PO), supportive care at home

-          Moderate to severe – steroids + racemic epi (can repeat as frequently as q20 minutes PRN)

Disposition:

-          Discharge: non-toxic, tolerates PO, watch and reassess after 3 hours if received racemic epi

-          Admission: persistent stridor at rest, tachypnea, accessory muscle use, hypoxia, or requirement of >2 treatments with racemic epi

 

Mapelli E, Sabhaney V. "Stridor and Drooling in Infants and Children." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eEds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, pg 800-801.