Pediatric Coughs: Croup


Valeria Wu, MD


Presentation:  commonly children 6 months to 3 years old, URI and develops into barking cough/hoarseness worse at night 

  • Usually viral, though can be bacterial 

Diagnosis: Clinical. If you get a chest x-ray, can see subglottic narrowing “steeples sign” 


Treatment: dexamethasone: 0.6 mg/kg PO or prednisolone 1 mg/kg PO 

  • antipyretics 

  • stridor at rest > nebulized epinephrine & observe for at least 3 - 4 hours, repeat as needed 

  • Repeated epinephrine treatments = admission 

  • Severe: consider intubation (go with smaller tube, airways may be edematous) 

Take noteRemember to keep your differential broad!


  • Epiglottitis (rare) - respiratory distress, tripoding, less likely to have cough, will have stridor and respiratory distress 

  • Bacterial tracheitis - stridor as well, productive cough, kid will look sicker, tender trachea/throat 

  • Foreign body - sudden onset, always have a suspicion for this 



Freire G, Shefrin A, Zemek R. Wheezing in Infants and Children. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill; Accessed October 29, 2020.