Cough and stridor with cry


• This child was treated with a single dose of dexamethasone 0.6 mg/kg orally and did not require any additional treatment.

• If he had stridor at rest, epinephrine nebulizer treatment would be indicated. Disposition

• This child was sent home from the ED after his dexamethasone dose.


• Shernaz Wadia, MD University of Louisville
• Matthew Hansen, MD Associate Professor Oregon Health & Science University


• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Mohamud Daya, MD Professor Oregon Health & Science University
• Douglas Baker, MD Professor Johns Hopkins University School of Medicine
• Craig Warden, MD Professor Oregon Health & Science University

• Croup
• Stridor

Differential Diagnosis

Differential diagnosis for child with acute-onset upper airway obstruction:

• Airway foreign body

• Bacterial tracheitis

• Epiglottitis

Patient Workup

• This child did not require further workup other than history and physical exam, which is the case with the vast majority of children with croup. • If there is concern for a foreign body, epiglottitis, or tracheitis, further studies may be indicated, such as X-rays of the neck and blood tests.

Suggested Approach

• Viral croup is the most common cause of acute airway obstruction in children aged 6 months to 6 years. In a child with classic symptoms, barky cough and inspiratory stridor, the diagnosis of croup is based on the history and physical examination alone. Less than 1% of children with acute onset of inspiratory stridor will have another diagnosis, including epiglottitis, bacterial tracheitis, or a foreign body aspiration. Nebulized epinephrine can provide rapid, relief of respiratory distress and is indicated if the patient has stridor while at rest. The onset is within 10 minutes, and the effect lasts 1-2 hours. One oral dose of dexamethasone 0.6mg/kg is the recommended treatment of mild and moderate croup where a barky cough is present and the patient may have stridor with agitation. The effect of the dexamethasone treatment will last several days usually through the worse part of the illness.

Suggested references

• Croup


• Gender: Male
• Age: 2 years
• Height: Not Available
• Weight: 29.8 lb/13.5 kg


• Temperature: 101.2 F/38.4 C
• Blood Pressure: 98/63
• Heart Rate: 150
• Respiratory Rate: 24
• Pulse Oximetry: 100% RA

Signs and Symptoms

Barky cough; stridor; fever


• None


• Lives with mom


• None

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