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Prednisone for croup.Diagnosis and management of croup in children
Diagnosis and management of croup in children
Prednisone for croup
Although most cases of croup resolve on their own, children with even mild disease are now routinely treated with corticosteroids and those with more moderate to severe disease with immediate nebulized adrenaline.
This article provides pediatricians and other pediatric healthcare providers with quick reference to the diagnosis and management of croup.
The goal is to help pediatricians accurately diagnose and treat these children as well as educate their parents on the symptoms of the illness to help them know when to call their physician or when a visit to the ED is warranted. Symptoms of croup can be similar to other respiratory diseases, so making the differential diagnosis is important to both treat appropriately and avoid unnecessary treatment.
Most cases of croup are from a viral infection called laryngotracheitis or are spasmodic called recurrent croup , although other conditions can mimic the symptoms of croup and need to be considered in making the differential diagnosis Table 1.
This article will focus on the diagnosis and treatment of croup, however pediatricians should be aware of recurrent croup and the potential for an underlying condition that may be masked by the persistence of croup symptoms Table 2. Croup related to a viral infection is most frequently caused by parainfluenza virus type 1 and less commonly, type 3.
Diagnosis is based primarily on history and physical examination. Most cases of viral croup are self-limiting and symptoms resolve on their own. This is followed by a barking cough and mild to severe degrees of respiratory distress, including nasal flaring, stridor, and respiratory retractions. Read more: Using Iggy and the Inhalers to teach asthma medication compliance.
The severity of respiratory distress is key to an accurate differential diagnosis as well as appropriate management, so assessment of the degree of airway obstruction is critical in the initial assessment. For children who present with severe respiratory symptoms not from viral croup, other diagnostic imaging and lab work may be helpful along with the history and physical examination to make the differential diagnosis Table 5. A single dose of a systemic corticosteroid is currently recommended as treatment of choice for croup, even in children with mild disease.
A single dose of nebulized budesonide 2 mg is indicated based on the current best evidence for children with mild to moderate or moderate to severe croup who are vomiting or unable to take oral medications.
Oral corticosteroids are preferred when tolerated, however, because they are more effective, convenient, and less expensive. The type of steroid given to children with croup depends almost entirely on local practice ie which hospital they live near.
Both of these medications have been used for decades in many conditions other than croup, and have proven safety records. Many doctors believe that prednisolone and dexamethasone are equally as effective as each other, but it is not known for certain whether one might be slightly more effective. A large clinical study, currently underway in Perth, hopes to answer this question. Find GPs in Australia. In the past, only children with severe croup were treated with steroids, because of concern about possible side effects.
Even though the chances of any side-effects are very small with a single dose of steroid, more recent clinical studies have shown that much lower doses of steroids are probably just as effective as the previously used higher doses.
Doctors generally now feel much more comfortable with treating mild cases of croup with steroids, because the benefit of treatment far outweighs the possible risks.
Steroid medications have revolutionised the treatment of croup over the last ten years or so. Many children who would previously have needed admission to hospital can now be treated with a single dose of steroid and allowed home sometimes after a period of observation.
It is important to note that the steroids do not treat the underlying viral infection, which caused the croup. By decreasing the swelling in the airway, steroids help to prevent increasing breathing difficulty and decrease the discomfort of breathing for the child.
Unfortunately, there is no known medication to successfully treat viruses causing croup, as they are basically the same viruses as those causing the common cold in adults. Cochrane Database Syst Rev. NHS website. London: Department of Health and Social Care; updated Clinical Knowledge Summary.
View commentaries on this research This is a plain English summary of an original research article Corticosteroids reduce symptoms of croup in children within two hours and continue to do so for at least 24 hours. Why was this study needed? What did this study do? What did it find? The rates of return visits or re admissions or both were halved by corticosteroids risk ratio 0. When given corticosteroids, of every 1, children treated will return for medical care, compared with of every 1, children treated with placebo.
What does current guidance say on this issue? What are the implications? Before applying consider whether the risk of distress negates the accuracy of monitoring. Assessment and management of viral croup in children: Viral croup.
Prescriber 27, 32— Bjornson, C. Nebulized epinephrine for croup in children. Cochrane Database Syst. Chub-Uppakarn, S. A randomized comparison of dexamethasone 0. Parker, C. Oral dexamethasone in the treatment of croup: 0. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial.
Sixteen years of croup in a Western Australian teaching hospital: effects of routine steroid treatment. A randomised double blinded trial. Emergency Medicine Australasia. Australian Edition. Back to top. Barking cough No stridor at rest No sternal recession or tracheal tug Normal behaviour.
Dexamethasone 1.
A common childhood upper-airway disorder, croup is among several respiratory illnesses that require pediatricians and other healthcare providers to make an accurate differential diagnosis to ensure appropriate treatment. It occurs most commonly in children aged between 6 months and 3 years and during the late autumn months, but sporadic cases can also occur any time of year and in older children.
Recommended: 'Red flags' for chronic cough. Although most cases of croup resolve on their own, children with even mild disease are now routinely treated with corticosteroids and those with more moderate to severe disease with immediate nebulized adrenaline.
This article provides pediatricians and other pediatric healthcare providers with quick reference to the diagnosis and management of croup. The goal is to help pediatricians accurately diagnose and treat these children as well as educate their parents on the symptoms of the illness to help them know when to call their physician or when a visit to the ED is warranted. Symptoms of croup can be similar to other respiratory diseases, so making the differential diagnosis is important to both treat appropriately and avoid unnecessary treatment.
Most cases of croup are from a viral infection called laryngotracheitis or are spasmodic called recurrent croupalthough other conditions can mimic the symptoms of croup and need to be considered in making the differential diagnosis Table 1.
This article will focus on the diagnosis and treatment of croup, however pediatricians should be aware of recurrent croup and the potential for an underlying condition that may be masked by the persistence of croup symptoms Table 2.
Croup related to a viral infection is most frequently caused by parainfluenza virus type 1 and less commonly, type 3. Diagnosis is based primarily on history and physical examination.
Most cases of viral croup are self-limiting and symptoms resolve on their own. This is followed by a barking cough and mild to severe degrees of respiratory distress, including nasal flaring, stridor, and respiratory retractions.
Read more: Using Iggy and the Inhalers to teach asthma medication compliance. The severity of respiratory distress is key to an accurate differential diagnosis as well as appropriate management, so assessment of the degree of airway obstruction is critical in the initial assessment. For children who present with severe respiratory symptoms not from viral croup, other diagnostic imaging and lab work may be helpful along with the history and physical examination to make the differential diagnosis Table 5.
A single dose of a systemic corticosteroid is currently recommended as treatment of choice for croup, even in children with mild disease. A single dose of nebulized budesonide 2 mg is indicated based on the current best evidence for children with mild to moderate or moderate to severe croup who are vomiting or unable to take oral medications. Oral corticosteroids are preferred when tolerated, however, because they are more effective, convenient, and less expensive. Still unclear and needing further investigation is the optimal dose range of dexamethasone and whether repeated doses of corticosteroids provide additional benefit in children with severe croup.
More: A new model for hospital-based pediatric care. For children with moderate to severe croup, the addition of nebulized epinephrine is indicated by the current best evidence. Although the optimal dose of nebulized epinephrine in this setting is unknown, a dose of 3 ml of L-epinephrine, solution, has been recommended.
Treatments that are not supported by the evidence, and therefore not recommended, include humidification therapy and Heliox. A number of algorithms have been proposed to facilitate treatment decisions based on the severity of croup. Figure 1 and Figure 2 provide examples of treatment algorithms based on recent systematic reviews of the literature. To date, good evidence is lacking on a standard to employ to admit a child to the hospital or to know when it is safe to discharge them from the ED.
Croup is a common childhood upper-airway disorder most frequently caused by viral infection and occurring most often in children aged between 6 months and 3 years. Because symptoms can mimic symptoms of other disorders, a differential diagnosis considering the degree of airway obstruction is critical to ensure appropriate management.
Standard treatment for all cases of croup regardless of severity is treatment with a single dose of a corticosteroid, with the addition of nebulized adrenaline for children with more moderate to severe disease.
Most children with croup will not need to be seen in the ED or need hospitalization. However, recognizing the signs and symptoms of more acute illness that does require hospitalization is important to reduce the number of unnecessary ED visits and hospitalizations.
Toward Optimized Practice Program. Guideline for the diagnosis and management of croup. Edmonton, Alberta: Alberta Medical Association. Revised January Accessed February 23, Croup: an overview. Am Fam Physician. Viral croup: diagnosis and a treatment algorithm. Pediatr Pulmonol. Fifteen-minute consultation: structured approach to management of a child with recurrent croup. Respiratory viruses in laryngeal croup of young children J Pediatr. Erratum in: J Pediatr. Malhotra A, Krilov LR.
Viral croup. Pediatr Rev. Erratum in: Pediatr Rev. Rajapaksa S, Starr M. Croup-assessment and management. Aust Fam Physician. Evidence based guideline for the management of croup. Everard ML. Acute bronchiolitis and croup. Pediatr Clin North Am. Ms Nierengarten, a medical writer in St.
Paul, Minnesota, has over 25 years of medical writing experience, coauthoring articles for Lancet OncologyLancet NeurologyLancet Infectious Diseasesand Medscape. She has nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.
Diagnosis and management of croup in children. March 1, Etiology and diagnosis Symptoms of croup can be similar to other respiratory diseases, so making the differential diagnosis is important to both treat appropriately and avoid unnecessary treatment.
NEXT: Further ways to diagnose croup Croup related to a viral infection is most frequently caused by parainfluenza virus type 1 and less commonly, type 3. Read more: Using Iggy and the Inhalers to teach asthma medication compliance The severity of respiratory distress is key to an accurate differential diagnosis as well as appropriate management, so assessment of the degree of airway obstruction is critical in the initial assessment.
Croup in children. Cherry JD, Clinical practice. N Engl J Med.
Corticosteroids may be warranted even for those children who present with mild symptoms. An updated Cochrane Review reported that. Corticosteroids reduce symptoms of croup in children within two hours and continue to do so for at least 24 hours. Prednisone treated croup equally effectively compared with dexamethasone. Commentary. Since the late s, multiple studies have demonstrated. Prednisolone (1 mg/kg) has been shown in 1 study to shorten the time to extubation for patients with croup in intensive care Many centers. Corticosteroids may be warranted even for those children who present with mild symptoms. An updated Cochrane Review reported that. Observations should be recorded at least hourly whilst in the emergency department.Croup is a condition, which occurs only in children. This is usually due to a respiratory virus and leads to a hoarse voice, barking cough and difficulty breathing. Croup is sometimes referred to as laryngotracheitis or laryngotracheobronchitis — meaning inflammation of the larynx voicebox , trachea windpipe and bronchi medium-sized air tubes in the lungs. Over the last ten years, the treatment of croup has become much more successful due to the use of steroid medications.
A number of clinical studies have proven that a single dose of steroid lessens the chance of a child needing admission to hospital. These medications also shorten the length of hospital stay, decrease the need for admission to Intensive Care, and shorten the length of stay in intensive care. There are two types of steroid medication being used for croup: dexamethasone and prednisolone.
Both of these are taken by mouth as a small amount of syrup or liquid. The most common side-effect for both medications is vomiting and unfortunately neither tastes particularly nice. Hospitals vary in their use of these medications; some use dexamethasone, while some use prednisolone. The type of steroid given to children with croup depends almost entirely on local practice ie which hospital they live near.
Both of these medications have been used for decades in many conditions other than croup, and have proven safety records. Many doctors believe that prednisolone and dexamethasone are equally as effective as each other, but it is not known for certain whether one might be slightly more effective.
A large clinical study, currently underway in Perth, hopes to answer this question. Find GPs in Australia. In the past, only children with severe croup were treated with steroids, because of concern about possible side effects. Even though the chances of any side-effects are very small with a single dose of steroid, more recent clinical studies have shown that much lower doses of steroids are probably just as effective as the previously used higher doses.
Doctors generally now feel much more comfortable with treating mild cases of croup with steroids, because the benefit of treatment far outweighs the possible risks. Steroid medications have revolutionised the treatment of croup over the last ten years or so. Many children who would previously have needed admission to hospital can now be treated with a single dose of steroid and allowed home sometimes after a period of observation.
It is important to note that the steroids do not treat the underlying viral infection, which caused the croup. By decreasing the swelling in the airway, steroids help to prevent increasing breathing difficulty and decrease the discomfort of breathing for the child.
Unfortunately, there is no known medication to successfully treat viruses causing croup, as they are basically the same viruses as those causing the common cold in adults. Therefore, your child will continue to have a cough and other viral symptoms runny nose, mild temperature for the next week or longer, despite having treatment for croup. Previous studies of croup have reported no significant side effects for either prednisolone or dexamethasone.
Some parents report benefit from mist, for example holding a child in the bathroom whilst turning on a hot shower, but controlled studies have shown conflicting results and it probably does not work.
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