This document provides clinical guidance for all staff involved in the care and management of a child
presenting to an Emergency Department (ED) with symptoms suggestive of croup in Queensland.
This guideline has been developed by senior ED clinicians and Paediatricians across Queensland, with
input from PICU and ENT staff, Queensland Children’s Hospital, Brisbane. It has been endorsed for use
across Queensland by the Queensland Emergency Care of Children Working Group in partnership with
the Queensland Emergency Department Strategic Advisory Panel and the Healthcare Improvement Unit,
Clinical Excellence Queensland.

• Croup is a common cause of airway obstruction in young children.
• Symptoms are usually mild to moderate (worse at night and on day two) and self-limiting but
can be severe and rarely, life-threatening.
• Avoid distressing a child with croup as this may exacerbate symptoms.
• Treatment includes corticosteroids and, in moderate to severe cases, nebulised adrenaline

Croup (acute laryngotracheobronchitis) is a clinical syndrome characterised by barking cough, inspiratory
stridor and hoarseness of voice, with or without respiratory distress.
 Onset may be abrupt, and is more
common at night. The illness is typically mild and self-limiting but can be severe and rarely, life-threatening.
Risk factors for severe croup
• prematurity 
• age less than six months
• underlying structural upper airway condition e.g. tracheomalacia, subglottic stenosis
• history of previous severe croup
• unplanned representation to ED within 24 hours of first croup presentation
• trisomy.
Management
Refer to Appendix 1 for a summary of the emergency management and medications for children presenting
with symptoms of croup.
There is no definitive treatment for the viruses that cause croup. Therapy is aimed at decreasing airway
oedema and providing supportive care (respiratory support and maintenance of hydration).
Recommended management includes:
• The appropriate use of corticosteroids and nebulised adrenaline. These interventions have
been shown to reduce the need for, and duration of endotracheal intubation, length of stay,
and representation rates to emergency services. 
• Nursing the child upright on carer's lap
Corticosteroids
Recommended for all children with croup. 
Oral corticosteroids take approximately 30 minutes to lessen respiratory distress,
and if not tolerated,
can be more reliably given via a nebuliser.  While not fully understood, corticosteroids are thought to
reduce airway oedema through an anti-inflammatory effect. 
Oral administration is recommended whenever possible. Advantages of oral over other methods include:
• less pain and distress for the child
• inexpensive and readily available
• quicker to administer