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Publication Date



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 revision 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. Standardization of care may reduce overutilization of chest radiographs, viral testing, and other laboratory testing. It may also decrease unnecessary hospitalization and inpatient length of stay.

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 patients 6 months to 6 years of age with croup (laryngotracheitis) seen in an acute care setting or emergency department, which patient characteristics are indicative of need for hospital admission?
  2. In children with croup, is observation time post racemic epinephrine dosing of 2 hours versus 3 or more hours efficacious in preventing treatment failure?


Croup; Prednisolone; Dexamethasone




Clinical Practice Guidelines are updated on a revision schedule. Primary files will always be the most current update. Previous revisions are available upon request from Children’s Mercy Library Services.

Finalized Feb 2016; Revised Nov 2022


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Pediatrics Commons