Educational revision — for learning, not live patient decisions. Guideline-linked. Always work with your seniors and local guidelines.
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  4. Croup (mild)
● Urgent care clinic · 30-minute consult

Croup (mild)

Barking cough without stridor at rest: one dose of dex and home.

Typical consult⏱ 15 min
Investigations🔬 None
Usual outcome💊 Dexamethasone 0.15 mg/kg once
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
▶ Practise this consult — work through a case and get a model note
1Rule out first — red flags
If you find……then
Stridor at rest, recession, agitation or lethargyModerate–severe croup — ED
Drooling, toxic, unable to swallow, no barking coughEpiglottitis / bacterial tracheitis — don’t examine throat, ED
SpO₂ < 92% or cyanosisED now
Under 6 months or recurrent croupAtypical — paediatric review
2What to ask
  • Barking cough, hoarse voice, coryza
  • Stridor — only when upset or also at rest?
  • Drinking, breathing, drooling
  • Age; previous croup; airway problems
3What to examine
  • Observe calmly on parent’s lap — don’t upset the child
  • RR, recession, stridor at rest, SpO₂
  • Colour, conscious level
4How to do it — the senior at your shoulder

Keep them calm

Crying worsens airway narrowing. Examine the child on the parent’s lap, avoid looking in the throat, and avoid unnecessary procedures.

Stridor at rest vs when upset

Stridor only when crying = mild. Stridor while settled and calm = at least moderate.

5Decide — investigate only if it changes the plan

Is it mild?

  • Stridor at rest
  • Chest wall recession
  • Agitation or lethargy
  • SpO₂ < 92% or cyanosis
  • Drooling / toxic appearance

Any present: Not mild → ED. None present: Mild croup → dexamethasone and home.

Croup severity

  • Mild: barking cough, no stridor or recession at rest
  • Moderate: stridor at rest, some recession, not agitated
  • Severe: marked recession, agitation or lethargy, cyanosis

Mild → dexamethasone and home with safety-netting. Moderate/severe → ED.

InvestigationOnly if…
NoneClinical diagnosis
6Treat & send home

Management & advice

  • Keep the child calm; sitting upright on a parent’s lap
  • Fluids; paracetamol/ibuprofen for discomfort
  • Steam/humidified air is not recommended
  • Symptoms often worse at night; usually settle in 2–3 days

Refer / follow-up

  • Stridor at rest, recession, low sats → ED
℞
Discharge prescription (TTO)Children: weight/age-based — always check the BNFc. Check allergies, renal function, pregnancy/breastfeeding and interactions. Tap BNF ↗ to confirm.
DrugDoseDuration / notes
Dexamethasone (oral) BNFc ↗0.15 mg/kg single doseOnce (per BNFc)
Paracetamol / ibuprofen BNFc ↗Dose by age/weight per BNFcFor discomfort
7Safety-net
Say it like this

Your child has croup, a viral infection that makes the cough barky. It’s often worse at night and usually gets better in 2 to 3 days. The single dose of steroid medicine helps the swelling. Keep them calm and upright. If they make a noisy breathing sound when resting calmly, their chest sucks in, they turn pale or blue, or they start drooling, call 999.

Come back / call 111 — or 999 if severe — if:

  • Noisy breathing (stridor) when calm and resting
  • Skin sucking in between the ribs or at the neck
  • Very drowsy, pale, blue or grey lips
  • Drooling or unable to swallow — call 999
8Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Croupnhs.uk/conditions/croup
9Where juniors slip up
  • Upsetting the child with a tongue depressor
  • Sending home with stridor at rest
  • Missing epiglottitis
▶Practise the decision

Revision practice. Work through a real or imagined case to rehearse the reasoning. It builds a model note to learn from. It doesn’t replace your judgement, your seniors or local guidance.

✎Blank clinic note template

Croup (mild) — clinic note

URGENT CARE — CROUP (MILD) PRESENTING COMPLAINT: HISTORY Barking cough, hoarse voice, coryza: Stridor — only when upset or also at rest?: Drinking, breathing, drooling: Age; previous croup; airway problems: RED FLAGS (record present / absent) [ ] Stridor at rest, recession, agitation or lethargy [ ] Drooling, toxic, unable to swallow, no barking cough [ ] SpO₂ < 92% or cyanosis [ ] Under 6 months or recurrent croup PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Observe calmly on parent’s lap — don’t upset the child: RR, recession, stridor at rest, SpO₂: Colour, conscious level: DECISION RULE — Is it mild?: result ______ INVESTIGATIONS: none required / None — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Croup Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Noisy breathing (stridor) when calm and resting - Skin sucking in between the ribs or at the neck - Very drowsy, pale, blue or grey lips - Drooling or unable to swallow — call 999 Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:
✓Guidelines

Doses are typical doses drawn from the guidance above. Always confirm in the current BNF/BNFc and your local antimicrobial policy.

More children

Pulled elbowTypical story, no X-ray, reduce and watch them play.ChickenpoxMostly reassurance — but avoid NSAIDs and spot the complications.Fever in a child (looks well)Traffic-light them, find the source, and safety-net the parents properly.Foreign body in ear or noseOne good attempt with the right technique — and batteries are an emergency.