Croup (Acute Laryngotracheitis) — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Severity grade
   Croup severity (stridor at rest/retractions)? (Clinical diagnosis (barking cough, hoarseness, inspiratory stridor). Mild = no stridor at rest (only on exertion/crying); moderate = stridor at rest + mild retractions; severe = stridor at rest + marked retractions/distress; altered consciousness/cyanosis/exhaustion = impending respiratory failure.)
   • Mild → Mild
   • Moderate–severe → Moderate–severe
   • Impending respiratory failure → Impending respiratory failure
2. [End] Mild
   Single dose of dexamethasone 0.6 mg/kg orally (or 0.15 mg/kg; IM/IV if oral not tolerated); symptomatic antipyretics, keep the child calm (crying worsens obstruction); no routine humidified mist. Outpatient observation, return advice.
3. [End] Moderate–severe
   Stridor at rest: single dose of dexamethasone 0.6 mg/kg + nebulized epinephrine (racemic epinephrine 2.25% 0.05 mL/kg, max 0.5 mL; or L-epinephrine 1:1000 0.5 mL/kg, max 5 mL); oxygen if hypoxic; observe ≥2–3 h after nebulization for rebound; admit if poor response or repeated dosing is needed.
4. [End] Impending respiratory failure
   Altered consciousness/cyanosis/exhaustion/quiet chest: oxygen, nebulized epinephrine, dexamethasone, prepare airway support (intubation if needed), ICU; keep calm and avoid agitation.

Source guidelines & references

• Diagnosis and management of croup (AAFP); Westley croup score

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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