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These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly, these guidelines should guide care with the understanding that departures from them may be required at times.

Objective of the Guideline

The objective of this guideline is to standardize and improve care for otherwise healthy children diagnosed with croup in the Emergency Departments(ED)/Urgent Care Centers (UCC), outpatient settings, and inpatient medical units.

Target Users

Physicians, nurse practitioners, and staff nurses caring for children with croup in EDs, UCCs, outpatient settings, and inpatient settings.

Clinical Questions Answered by Guideline

1. In children with croup, is prednisolone as efficacious as dexamethasone to resolve symptoms?

2. In children with croup, what is the recommended dose, frequency, and route of administration (oral vs. IM) of dexamethasone and prednisolone?

3. In children with croup, how long should observation be post racemic epinephrine dose and is there a rebound effect?

4. In children with croup, what are the criteria for admission?

5. In children with croup, are x-rays needed in the management of croup?

6. In children with croup, when is an ENT consultation necessary?

7. Are there valid and reliable croup scores to classify children with croup?


Croup; Prednisolone; Dexamethasone




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