Changing hospital management of croup. What does this mean for general practice?

BACKGROUND

The hospital management of croup has altered significantly over the last decade, with current data suggesting that all children with croup who demonstrate an increase in difficulty breathing should be treated with corticosteroids, and children with more severe croup should be treated with nebulised adrenaline.

OBJECTIVE

To discuss the assessment of croup severity, the recent changes in treatment and to make suggestions for the management of croup in general practice.

DISCUSSION: Children with mild croup require reassurance. There is no evidence that steroids have a place in management in this group. A single dose of prednisolone is appropriate for children with stridor at rest, but no recession and they can be managed in the general practice setting provided they can be reviewed within 2-4 hours. Failure to improve after treatment with steroids means hospital referral. Children with more severe croup require hospital assessment and possible admission.