Croup barks and is gradual; epiglottitis drools and is sudden
Expansion
| Croup | Epiglottitis | |
|---|---|---|
| Onset | Gradual, over days | Sudden, over hours |
| Cough | Barking, seal-like | Absent or minimal |
| Voice | Hoarse | Muffled, “hot potato” |
| Drooling | No | Yes, cannot swallow |
| Posture | Any | Tripod, sitting forward |
| Fever | Low grade | High, toxic |
| Cause | Parainfluenza virus | Haemophilus influenzae type b |
| Radiograph | Steeple sign on AP | Thumb sign on lateral |
“Croup barks, epiglottitis drools.”
Croup is common, in children aged 6 months to 3 years, worse at night. Treat with a single dose of oral dexamethasone 0.15 mg/kg for any severity, plus nebulised adrenaline and oxygen if severe. Most are managed at home.
Epiglottitis is now rare because of Hib vaccination, but it is an airway emergency. Do not examine the throat, take blood, cannulate or lie the child down: any distress can precipitate complete obstruction. Call the most senior anaesthetist and ENT surgeon, keep the child calm with the parent, and secure the airway in theatre before anything else.
Other causes of stridor: inhaled foreign body (sudden, with a choking episode), bacterial tracheitis, anaphylaxis and retropharyngeal abscess.