Childhood croup.

Hoarseness, whooping cough and strider are elements of a syndrome of upper airway obstruction. In childhood, acute laryngotracheobronchitis Is by far rile commonest cause of this syndrome. Yet, the differential diagnosis incl udes a number of rare and severe entities. In many cases, the traditional d istinction between viral and spasmodic types is not possible. The value of humidifying therapy has nor been established. In severe cases, nebulized ad renaline is of benefit bur should be reserved for hospital. The effect last s only two hours and at times a rebound effect is observed. It is now reali zed that some patients treated with adrenaline can safely be discharged aft er a two to three hours observation. There is a large body of evidence that all children arriving at the emergency department with croup should receiv e steroids without delay. Tills policy results in a much better outcome, wi th important reduction in hospitalizations, intensive care unit admissions and incubations. Oral dexamethasone is the drug of choice it is as effectiv e, easier to administer and cheaper than nebulised budesonide. In most stud ies, dexamethasone has been used at a dose of 0.6 mg/kg but there is some e vidence that 0.15 mg/kg may be just as effective. (C) 1999 Elsevier, Paris.