Suspected Pediatric Croup
Child with barking cough, stridor, hoarse voice
All Pathways
PediatricsEmergency
Pediatric Croup Management (CPS 2017)
Pediatric Croup Management (CPS 2017): Suspected Pediatric Croup → Assess Severity (Westley Score) → All Patients: Dexamethasone → Mild Croup.
Pathway Overview
9 steps
Algorithm Steps
9 total
01Start 02Action Assess Severity (Westley Score)
Clinical assessment
- MILD (0-2):
- • Occasional barking cough
- • No stridor at rest, no retractions
- MODERATE (3-7):
- • Frequent barking cough
- • Stridor at rest, mild-mod retractions
- • No agitation/distress
- SEVERE (8-11) or >11:
- • Stridor at rest, severe retractions
- • Decreased air entry
- • Agitation, lethargy, cyanosis
03Action All Patients: Dexamethasone
Single dose corticosteroid
- DEXAMETHASONE 0.6 mg/kg PO/IM
- • Maximum dose: 10-16 mg (typically 10mg)
- • Oral preferred if tolerated
- • Single dose is effective
- Lower dose (0.15-0.3 mg/kg) may be equally effective
- Onset: 2-3 hours
- Duration: 24-48 hours
04Outcome Mild Croup
Discharge after dexamethasone
- Observe 30-60 min post-dexamethasone
- Educate parents on warning signs
- Return if stridor at rest or worsening
- No further treatment needed
- Humidified air NOT proven effective
05Action Moderate Croup
Add observation, consider nebulized epi
- Give dexamethasone (if not already)
- Minimize disturbance (keep child calm)
- If stridor at rest persists:
- • Nebulized epinephrine
- • L-epinephrine (1:1000): 0.5 mL/kg (max 5 mL)
- • OR Racemic epinephrine 2.25%: 0.05 mL/kg (max 0.5 mL)
- Observe 2-4 hours after epinephrine
06Decision Status After Epinephrine?
Observe 2-4 hours for rebound
07Outcome Improved - Discharge
Safe for home
- No stridor at rest after observation
- Able to take fluids
- Parents understand warning signs
- Return precautions:
- • Stridor at rest returns
- • Increased work of breathing
- • Decreased oral intake
- • Fever develops (consider bacterial)
08Action Not Improved - Admit
Hospital admission
- Persistent stridor at rest
- Required multiple doses of epinephrine
- Hypoxia
- Inadequate oral intake
- Parental concern/reliability
- Consider ICU if:
- • Respiratory failure
- • Need for repeated epinephrine
- • Consider alternative diagnosis
09Warning Severe Croup
Urgent treatment required
- Keep child calm (on parent's lap)
- Minimize interventions that cause distress
- NEBULIZED EPINEPHRINE immediately
- • L-epinephrine: 0.5 mL/kg (max 5 mL)
- • May repeat in 15-20 min if needed
- DEXAMETHASONE 0.6 mg/kg PO/IM
- OXYGEN if SpO2 <92%
- Prepare for possible intubation
- Heliox if available and trained
- Path rejoins step 06Shared downstream outcome
Guideline Source
CPS Practice Point: Acute Management of Croup 2017
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Excludes bacterial tracheitis, epiglottitis, foreign body
- Ages 6 months to 6 years typically
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Pediatric Croup Management (CPS 2017)?
The Pediatric Croup Management (CPS 2017) is a emergency clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on CPS Practice Point: Acute Management of Croup 2017.
What guideline is the Pediatric Croup Management (CPS 2017) based on?
This algorithm is based on CPS Practice Point: Acute Management of Croup 2017 (DOI: 10.1093/pch/pxx019).
What are the limitations of the Pediatric Croup Management (CPS 2017)?
Known limitations include: Excludes bacterial tracheitis, epiglottitis, foreign body; Ages 6 months to 6 years typically. Individual patient factors may require deviation from these recommendations.
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