Acute Laryngo-Tracheo Bronchitis (Croup)


Acute Laryngo-Tracheo bronchitis is a respiratory infection of the upper and lower tract affecting children 2-3 years of age.

It causes significant sub-glottic oedema
Most common aetiology is parainfluenza
virus infection preceded by an upper respiratory tract infection.

Symptoms and clinical features of Croup

  • Fever
  • Hoarseness
  • ‘Bovine cough’
  • Inspiratory stridor

Differential diagnosis

  • Acute epiglottitis

Complication of croup

  • Respiratory obstruction


  • Radiograph of the neck (postero-anterior view)

Treatment for croup

Treatment objectives

  • Prevent asphyxiation
  • Treat inflammatory oedema

Supportive measures

  • Humidification
  • Hospitalization may be necessary

Drug treatment

Nebulized epinephrine

  • Child: 400 micrograms/kg (maximum 5 mg)
  • Repeat after 30 minutes if necessary



  • Child 1 month -18 years: 10 – 100 micrograms/kg orally daily in 1 – 2 divided doses, adjusted according to response up to
    300 micrograms/kg daily especially in emergencies
  • Give parenterally in more severe cases
  • May repeat dose after 12 hours if necessary


  • Effects of nebulized epinephrine last 2 – 3 hours; the child should be monitored carefully for recurrence of the obstruction

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