Croup by Stewart Harsant and Taylor Fischer, PA-Cs

Croup, or laryngotracheitis, is a common viral infection of the upper airway in children under six, characterized by a distinct barking cough and potential stridor. Diagnosis relies on clinical presentation, as labs and imaging are rarely necessary, though neck x-rays may occasionally reveal a steeple sign. Management focuses on reducing airway obstruction and improving oxygenation, primarily through a single dose of dexamethasone. For moderate to severe cases involving stridor at rest, nebulized epinephrine serves as the first-line intervention. Clinicians must differentiate croup from more critical conditions like epiglottitis, retropharyngeal abscess, and foreign body aspiration. Discharge is appropriate for non-toxic patients who maintain adequate hydration and have reliable follow-up, while those exhibiting persistent stridor at rest or signs of respiratory failure require admission for further monitoring and potential intervention.