• Harsh barking cough
  • Hoarse voice
  • Stridor
  • Respiratory distress


  • Inhaled foreign body
  • Bacterial tracheitis
  • Angioedema
  • Tracheomalacia
  • Epiglottitis
  • Retropharyngeal abscess
  Mild Moderate Severe
Barking cough Occasional Frequent barking cough. Frequent barking cough.
Stridor None at rest Easily audible stridor at rest Prominent inspiratory (+/- expiratory) stridor at rest.
Recession None / mild Moderate Severe
Distress / Agitation None None – slight Significant
Level of consciousness Playful/ Oral intake

Can be placated. 

Interested in  surroundings

Difficult to placate or may be lethargic / restless



None 0

On crying 1

At rest 2

Severe (biphasic) 3


None 0

On crying/exertion 1

At rest 2

Severe 3

Admit If:

  • Stridor at rest
  • CROUP score >3


ORAL DEXAMETHASONE 150microg/kg STAT (maximum 8 mg,)

Nebulised Budesonide 2 mg as a single dose (Repeat after 12 hours)

o  Nebulised Adrenaline

1:1000 (1mg/ml) 0.4 ml/kg/dose STAT, (maximum 5 ml)

o  CONSIDER PICU if the croup score is >5.

o IV Dexamethasone must be used only after the child’s airway is made secure.

  1. Good information in brief.good work but some topics are missed and need improvement by addind lab investigation and case example

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