Upper respiratory infection (“acute laryngotracheobronchitis”) of young children, typically parainfluenza but can be RSV, enterovirus etc.

Classically barking cough, like a seal, with stridor. Often worse on waking, then settles once the panic has passed.

Mild fever typical. Rarely lasts longer than 24 hours.

Severe will cause increasing respiratory distress, with decreasing volume of stridor until respiratory arrest ensues.

An oxygen requirement implies lower rather than upper airway involvement (so the wrong, or mixed, diagnosis), or impending respiratory arrest.

Management

Supportive, and hands off – upsetting the child will provoke worsening of symptoms.

Paracetamol/difflam spray for the throat.

Recurrent croup

Some kids are prone to recurrent croup. Often strong family history of croup. Smoking doesn’t appear to be a factor!  Appears to be same viruses. Tend to be children with reflux and/or atopy.  [Pediatrics International, 51: 661–665.] [Annals of Otology, Rhinology & Laryngology 2008;117(6):464-69

26% have microlaryngobronchscopy findings suggestive of reflux – a clinical history is not predictive.  91% responded well to anti-reflux treatment.  High rate of recurrence in group with negative findings!  Kubba Journal of Laryngology and Otology 2013;127(5):494-500

Airway abnormalities eg tracheomalacia are common in children with recurrent croup and cannot be ruled out based on history (although biphasic stridor is highly suggestive). Having said that, most of the airway abnormalities will have a history of previous intubation, or are younger than 1 year, or are seen while inpatients, which all suggest pretty severe episodes. [Otolaryngology-Head and Neck Surgery 2011;144(4):596-601]

Foreign bodies, respiratory papillomatosis, double aortic arch reported.