Croup is a viral infection that causes swelling around the voice box and upper trachea, mostly in children between 6 months and 3 years. It gives a barking cough and stridor, often worse at night, and most children improve with a single dose of steroid.
Key symptoms
- Barking, seal-like cough
- Hoarse voice
- Noisy breathing in (stridor), worse when upset
- Mild fever and runny nose first
What you find on exam
- Keep the child calm on the parent's lap; do not look in the throat with force
- Stridor at rest versus only when crying
- Retractions, breathing rate and oxygen saturation
- Alertness and color; drooling or toxic look suggests another cause
Tests
- Diagnosis is clinical
- Pulse oximetry
- Neck X-ray only if the diagnosis is unclear
Treatment basics
- Oral dexamethasone single dose for all severities
- Nebulized epinephrine for stridor at rest
- Oxygen if saturation is low, given in a way that does not upset the child
- Observe for a few hours after epinephrine before discharge
Red flags
- Stridor at rest or severe retractions
- Drowsiness, agitation or cyanosis
- Drooling, high fever or a toxic look
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NCSBN 2026 NCLEX-RN Test Plan. Written by Making Synapses. Making Synapses is not affiliated with these organizations.