Understanding Croup

Jason T
Aug 12
4 min read

Updated: Aug 23

Croup in children, nursing treatment plan and assessment.

Understanding Croup: A Clinical Guide for Nursing Students

Keywords: croup in children, pediatric croup, nursing care plan for croup, dexamethasone croup treatment, nursing assessment croup, viral croup management, pediatric respiratory distress.

Overview

Croup (laryngotracheobronchitis) is a common respiratory illness seen in pediatrics, particularly in children aged 6 months to 5 years. It is most often caused by parainfluenza virus, but other viruses such as RSV, adenovirus, influenza, and rhinovirus can also be responsible. The infection leads to swelling of the larynx and trachea, producing the characteristic barking cough, hoarseness, and sometimes inspiratory stridor.

Heal Handout - Barky Cough (Croup)

Why this is important: For nursing students, understanding croup is essential because it represents one of the most frequent pediatric respiratory emergencies. Early recognition can prevent deterioration to life-threatening airway obstruction. Nurses are often the first healthcare providers to assess these children, so rapid, accurate identification of severity is critical.

What does Croup Sound like?

Assessment & Severity Classification

Key assessment points:

Onset, duration, and severity of symptoms
Signs of respiratory distress: retractions, nasal flaring, tachypnea, cyanosis
Presence of stridor at rest (a key severity marker)
Oxygen saturation and hydration status
Ruling out other emergencies like epiglottitis or foreign body aspiration

Severity can be graded using the Westley Croup Score:

Mild: occasional barking cough, no stridor at rest
Moderate: stridor at rest, mild–moderate retractions
Severe: marked retractions, agitation or lethargy, hypoxia

Why this is important: Accurate severity assessment helps guide urgent treatment decisions, prevents delays in escalation of care, and ensures patients are monitored at an appropriate level of acuity.

Types of Croup

Viral (Typical) Croup: Gradual onset from a cold, possible fever, barking cough, hoarseness, and stridor. Spasmodic Croup: Sudden nighttime onset, usually afebrile, often allergy-related, with abrupt respiratory distress.

Why this is important: Nursing students must differentiate between types because spasmodic croup can appear abruptly without warning, while viral croup often has a preceding cold. This distinction impacts both triage urgency and parental education.

Evidence-Based Interventions

Pharmacologic:

Dexamethasone (0.15–0.6 mg/kg): First-line therapy for mild to severe croup.
Nebulized epinephrine: Used in moderate/severe cases to rapidly reduce airway swelling.
Oxygen therapy: For hypoxic or severely distressed patients.

Supportive:

Cool mist humidifier or brief exposure to cool night air
Hydration and rest
Parental reassurance

Why this is important: Nursing students should understand both the medication protocols and the rationale for non-pharmacologic support. This knowledge is key for implementing evidence-based care and preventing unnecessary or harmful interventions.

Nursing Care Plan Essentials

Possible Diagnoses:

Ineffective airway clearance
Impaired gas exchange
Anxiety (child/guardian)

Interventions:

Continuous respiratory monitoring
Safe and timely medication administration
Education on red flag symptoms

Why this is important: Nursing care plans are not just documentation—they are structured approaches to problem-solving. In respiratory illnesses like croup, care planning ensures interventions are prioritized to protect airway and oxygenation first.

Parental & Caregiver Education

Parents should be advised to seek immediate help if their child develops stridor at rest, appears lethargic, has trouble swallowing, or turns blue. Home management for mild croup includes hydration, rest, and cool air exposure.

Why this is important: Education reduces emergency department visits for mild cases while ensuring timely intervention for severe ones. It also empowers caregivers to respond calmly and effectively.

Clinical Case Scenario - TEST YOURSELF

Scenario: You are a pediatric nurse in an urgent care clinic. A mother brings in her 2-year-old child who woke suddenly in the night with a barking cough and hoarse voice. The mother reports mild cold symptoms earlier but no fever. On assessment, you note inspiratory stridor when the child cries, mild sternal retractions, and oxygen saturation of 96% on room air.

Question 1:

What is the most likely diagnosis?

A) Asthma exacerbation
B) Viral croup
C) Epiglottitis
D) Foreign body aspiration

Question 2:

What is the most appropriate first-line treatment?

A) Oral dexamethasone
B) IV antibiotics
C) Nebulized salbutamol
D) Chest physiotherapy

Question 3:

Which sign would indicate progression to severe croup?

A) Occasional barking cough
B) Stridor at rest with lethargy
C) Mild sternal retractions only when crying
D) Fever of 37.5°C

Question 4:

What home care advice should be provided for mild croup?

A) Keep the child in a warm, dry room
B) Use cool mist or take the child briefly outside in cool night air
C) Avoid giving any fluids to prevent aspiration
D) Give over-the-counter cough suppressants

ANSWERS AT BOTTOM OF POST - HOW DID YOU DO?

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Just Remember:

Protect Yourself. Call 911.Don’t Waste Time.

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RESOURCES:

Author - Saving Grace Medical Academy Ltd

Jason T

Retired EMT - Heart & Stroke Foundation Senior Instructor

ANSWERS

Answer: B – Viral croup Explanation: Barking cough, hoarseness, and inspiratory stridor—especially at night—are hallmark signs of croup.
Answer: A – Oral dexamethasone Explanation: Corticosteroids are the standard first-line treatment for mild to moderate croup.
Answer: B – Stridor at rest with lethargy Explanation: Indicates severe airway obstruction and possible impending respiratory failure.
Answer: B – Use cool mist or night air