Stridor

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Definition: Harsh noise made when a child breathes in

Management of croup at the primary level

• If no stridor at rest, do not give antibiotics.
• If there is stridor at rest or chest indrawing or fast breathing refer urgently to hospital for possible intubation or tracheostomy and a course of cloxacillin and chloramphenicol.

Mild croup

• Stridor present only when upset.
• Likely to be of viral origin. An antibiotic is not required. Home care.

Severe croup (Laryngotracheobronchitis)

This is stridor in a calm child at rest with chest indrawing.

Refer to higher centre of care.

Do not examine the throat in case it's Epiglottitis!

If referral not possible or there is a delay give chloramphenicol or ceftriaxone and cloxacillin:

	Medicine	Paed Dose	Frequency	Duration
	chloramphenicol iv	12.5mg/kg	6 hourly	7 days
or	ceftriaxone iv	50mg/kg	once daily	7 days
and	cloxacillin iv	2.5-25mg/kg	6 hourly	7 days

• Suspect epiglottitis if child very ill, toxic and drooling saliva.
• Continue antibiotics
• Watch carefully for signs of obstruction. Intubation or a tracheostomy may be required (poor air entry; severe chest indrawing, restlessness, pallor).
• Minimal handling (keep on mother's lap)
• NB. Remember cyanosis is a very late sign.