UMEM Educational Pearls

- If child is <6 months think: laryngomalacia and if >6y-3y/o think croup
- The differential of child with stridor <6m:
Ø  laryngomalacia
Ø  vocal cord paralysis
Ø  subglottic stenosis
Ø  vascular ring structures
- Other causes of stridor: tracheitis, epiglottitis, trauma, foreign body, deep neck space infection
- Tips for the treatment of croup:
Ø  Dexmethasone is superior to prednisolone. Start dexmethasone  at 0.15-0.6 mgkg. Typically one time dosing is sufficient. PO/IM forms are considered equivalent.
Ø  A 2011 Cochrane review found no difference in the type of nebulized epinephrine used.
Ø  If regular epinephrine dosing is 0.5 ml/kg of 1:1000. If 2.25% racemic epinephrine, give 0.05 ml/kg.
Donaldson D, et al. Intramuscular versus oral dexamethasone for the treatment of moderate-to-severe croup: a randomized, double-blind trial. Acad Emerg Med. 2003 Jan;10(1):16-21.
Leung AKC, Cho H. Diagnosis of stridor in children. Am Fam Physician. 1999 Nov 15;60(8):2289-2296.
Sparrow A, Geelohoed G.  Prednisolone versus dexamethasone in croup: a randomised equivalence trial. Arch Dis Child. 2006 Jul;91(7):580-3.