PEDIATRICS
DIFFERENTIAL
■ Pneumonia
■ Asthma exacerbation
■ Viral infections, such as URI or croup
■ Aspirated foreign body
DIAGNOSIS
■ Rapid antigen testing of nasopharyngeal sample
■ CXR may show patchy atelectasis.
TREATMENT
■ Supplemental O 2
■ Racemic epinephrine nebulizer may be effective.
■ Antibiotics, if there is concern of 2° bacterial infection (acute otitis media,
pneumonia, UTI)
■ Steroids are generally not indicated unless the child has an underlying
condition such as asthma or BPD.
COMPLICATIONS
■ Apnea or respiratory failure
■ Dehydration
■ Rarely 2° bacterial infections
CROUP
■ Croup is a viral infection of the upper airway which is most commonly
caused by parainfluenza virus. Other etiologies include influenza, RSV,
and adenoviruses.
■ Affected children are 6 months to 3 years. Peak prevalence in the ages of
1–2 years.
■ Peak incidence is fall to winter.
■ Symptoms may last 3–7 days.
SYMPTOMS/EXAM
■ Stridor with retractions and tachypnea, usually worse at night
■ Prodrome of cough, coryza prior to onset of stridor
■ Barking cough (sounds like the bark of a seal)
■ Fever
DIFFERENTIAL
■ Other causes of stridor include: Foreign body aspiration, hemangiomas,
papillomas, subglottic stenosis.
■ Epiglottitis
■ Retropharyngeal abscess
DIAGNOSIS
■ Clinical diagnosis
■ Soft tissue neck X-ray may reveal classical “steeple sign”due to symmetric
narrow of the supraglottic airway (see Figure 5.23). It may also help to
exclude other causes of stridor.
■ CXR to exclude pneumonia or aspirated foreign body
RSV bronchiolitis often gets
worse in the second or third
day of the illness. Symptoms
are often worse at night.Neck radiographs in croup
may show the classical
“steeple sign” due to
symmetric narrowing of the
trachea.