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Croup - Management
What advice should I give to parents?

  • Explain that croup is self limiting and symptoms usually resolve within 48 hours, although occasionally they may last for up to a week. Resolution of croup symptoms is usually followed by symptoms of upper respiratory tract infection.
  • Advise the use of paracetamol or ibuprofen to control fever and pain:
    • Do not over- or under-dress a child with fever.
    • Tepid sponging is not recommended.
    • Do not routinely give antipyretic drugs to a child with fever with the sole aim of reducing body temperature.
  • Ensure an adequate fluid intake.
  • Do not advise humidified air (e.g. steam inhalation).
  • Arrange to review the child within a few hours, either by face-to-face consultation or by telephone. Advise parents to seek urgent medical advice:
    • If there is progression from mild to moderate airways obstruction, such as development of intermittent stridor at rest or increased effort of breathing (chest and suprasternal indrawing), as the child may need to be observed in hospital.
    • If the child becomes toxic (pale, very high fever, tachycardic) as this may mean the child has an alternative diagnosis (e.g. bacterial tracheitis or epiglottitis).
  • Advise the parents to call for an emergency ambulance if the child:
    • Becomes cyanosed.
    • Is unusually sleepy.
    • Is struggling to breathe.
  • Explain that cough medicines, decongestants, and short-acting beta-agonists are not effective. Croup is usually a viral illness and antibiotics are not needed.

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