close

Log in

Access to premium content is restricted to healthcare professionals / registered members. Login with your email address to continue.

Forgot Your Password?

Don't have an account? Sign up

By signing in or creating an account, you agree to our Terms and conditions and Privacy notice

This site is intended for Healthcare Professionals only
Back to CKS

Child health Ear, nose and throat Respiratory

Croup

Last revised in May 2022

Croup (laryngotracheobronchitis) is a common childhood disease that is usually caused by a virus.

Croup: Summary

  • Croup (laryngotracheobronchitis) is a common respiratory disease that typically occurs in children aged between 6 months and 3 years.
  • It is most commonly caused by a virus, typically parainfluenza virus types 1 or 3, and is characterized by the sudden onset of a seal-like barking cough, which may be accompanied by voice hoarseness, stridor, and/or respiratory distress. 
    • Symptoms are typically worse at night and increase with agitation.
    • Prodromal, non-specific upper respiratory tract symptoms (cough, rhinorrhoea, coryza, and fever) may have been present for between 12 and 72 hours. 
    • The clinical features of croup result from inflammation, swelling of upper airway structures (larynx, vocal cords and trachea), and oedema, leading to narrowing of the subglottic region.
  • Croup symptoms can be categorized as:
    • Mild — seal-like barking cough but no stridor or sternal/intercostal recession at rest.
    • Moderate — seal-like barking cough with stridor and sternal recession at rest. There is no (or little) agitation or lethargy.
    • Severe — seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
    • Impending respiratory failure — increasing upper airway obstruction, sternal/intercostal recession, asynchronous chest wall and abdominal movement, fatigue, pallor or cyanosis, decreased level of consciousness or tachycardia. The degree of chest wall recession may diminish with the onset of respiratory failure as the child tires. 
  • Children with mild croup can usually be managed at home. 
    • Symptoms usually resolve within 48 hours, although some episodes may last for up to one week.
    • Parents/carers should be advised to give paracetamol or ibuprofen to control fever and pain and to seek urgent medical advice if there is any deterioration.
    • Hospital admission may be required in some cases, for example if there is chronic lung disease, congenital heart disease, immunodeficiency, respiratory rate of over 60 breaths/minute, high fever, or inadequate fluid intake.
  • Children with moderate or severe croup, or impending respiratory failure should be admitted to hospital.
  • All children with croup (mild, moderate, or severe) should receive a single dose of oral dexamethasone (0.15 mg per kg body weight). If the child is too unwell to receive oral treatment, inhaled budesonide (2 mg nebulised as a single dose) or intramuscular dexamethasone (0.6 mg/kg as a single dose) are possible alternatives.

Have I got the right topic?

From age 3 months to 6 years.

This CKS topic covers the primary care management of croup.

This CKS topic does not cover the secondary care management of croup or the use of nebulized adrenaline for the management of croup.

There are separate CKS topics on Common cold, Cough - acute with chest signs in children, Feverish children - risk assessment and management, and Sore throat - acute.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare.

How up-to-date is this topic?

Changes

May 2022 — reviewed. A literature search was conducted in April 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

Previous changes

February 2019 — minor update. Tachycardia has been added as a sign of impending respiratory failure. High fever and 'toxic' appearance have been added as considerations for hospital admission. 

April to May 2017 — reviewed. A literature search was conducted in April 2017 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic. The topic has undergone restructuring. No major changes to the recommendations have been made.

September 2012 — reviewed. A literature search was conducted in September 2012 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. No changes to clinical recommendations have been made.

July 2011 — minor update. More exact paracetamol dosing for children has been introduced by the Medicines and Healthcare products Regulatory Agency (MHRA). Prescriptions have been updated to reflect the revised dosing. 

June to September 2008 — this is a new CKS topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

Update

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 May 2022.

HTAs (Health Technology Assessments)

No new HTAs since 1 May 2022.

Economic appraisals

No new economic appraisals relevant to England since 1 May 2022.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 May 2022.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 May 2022.

New policies

No new national policies or guidelines since 1 May 2022.

New safety alerts

No new safety alerts since 1 May 2022.

Changes in product availability

No changes in product availability since 1 May 2022.

Goals and outcome measures

Goals

To support primary healthcare professionals to:

  • Make an accurate diagnosis of croup.
  • Assess the severity of croup.
  • Treat croup in primary care where appropriate.
  • Refer to secondary care if necessary.
  • Provide appropriate advice to parents/carers.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

NICE have published quality standards on Fever in under 5s:

  • Statement 2: Infants and children under 5 years who are seen in person by a healthcare professional have their temperature, heart rate, respiratory rate and capillary refill time measured and recorded if fever is suspected.
  • Statement 4: Parents and carers who are advised that they can care for an infant or child under 5 years with unexplained fever at home are given safety net advice, including information on when to seek further help.

[NICE, 2014]

Background information

What is it?

  • Croup (laryngotracheobronchitis) is a common respiratory disease that typically occurs in children aged between 6 months and 3 years.
  • It is most commonly caused by a virus, typically parainfluenza virus types 1 or 3, and is characterized by the sudden onset of a seal-like barking cough, which may be accompanied by voice hoarseness, stridor, and/or respiratory distress.  
    • Symptoms are typically worse at night and increase with agitation.
    • Prodromal, non-specific upper respiratory tract symptoms (cough, rhinorrhoea, coryza, and fever) may have been present for between 12 and 72 hours. 
    • The clinical features of croup result from inflammation, swelling of upper airway structures (larynx, vocal cords and trachea), and oedema, leading to narrowing of the subglottic region.

[Johnson, 2016; Wright, 2016; BMJ, 2019]

How common is it?

  • Croup is a frequent cause of acute respiratory distress in young children. It mostly affects children between the ages of 6 months and 3 years and peaks in the second year of life. It is uncommon after the age of 6 years.
  • Boys are slightly more commonly affected than girls, with a ratio of around 1.4 to 1. 
  • Hospital admissions due to croup peak in late autumn (September to December), but cases occur all year round.
  • An observational study in a US paediatric group practice found croup to be the confirmed diagnosis in 15% of all cases of lower respiratory infection [Denny, 1983].
  • Parainfluenza virus epidemics tend to occur every other year, resulting in a 50% increase in the number of children admitted with croup during these periods.

[Johnson, 2016; Wright, 2016; BMJ, 2019]

What are the risk factors?

  • Risk factors for croup include:
    • Young age — croup most commonly affects children aged between 6 months and 3 years. However, it has been reported to occur in infants younger than 6 months, adolescents, and, more rarely, in adults.
    • Male sex — more boys are affected, with a male to female ratio of 1.4 to 1.
    • Previous intubation — a weak link between a history of previous intubation and croup has been suggested, but the evidence for this is currently considered to be weak.

[Johnson, 2016; Wright, 2016; BMJ, 2019]

What is the prognosis?

  • Symptoms of croup usually resolve within 48 hours, although some episodes may last for up to one week.
    • Mild croup is usually self-limited without treatment, but there is a shorter time to resolution with dexamethasone treatment.
    • Moderate croup usually resolves without significant complications, though the symptoms of obstruction may be frightening for parents/carers.
    • With dexamethasone and nebulised epinephrine combination treatment, the prognosis for severe croup is excellent.
  • Severe upper airway obstruction can, rarely, lead to respiratory failure and arrest.
    • In children with impending respiratory failure, intubation is required in 1–3% of cases.
    • Death from croup is rare, occurring in no more than 1 in every 30,000 cases.

[Bjornson and Johnson, 2013; Johnson, 2016; Wright, 2016; BMJ, 2019]

Diagnosis of croup

When should I suspect croup?

A diagnosis of croup is made clinically on the basis of a compatible history and examination findings. Investigations are rarely helpful. 

  • Suspect croup in a child with a sudden onset of a seal-like barking cough. Hoarse voice is also common.
    • Symptoms are typically worse at night and increase with agitation.
    • Prodromal, non-specific upper respiratory tract symptoms (coryza, non-barking cough, mild fever) may have been present for between 12 and 72 hours. 
    • Progressive upper airway obstruction can result in the development of stridor and respiratory distress. 
  • When examining a child with croup:
    • Take care not to frighten the child as agitation can worsen symptoms. 
    • Ensure the child is seated comfortably in the parent/carer's lap, to ensure comfort.
    • Do not reposition the child from the posture they have naturally adopted as this will be one that minimises airway obstruction.
  • Categorize the severity of the symptoms and signs to guide management options:
    • Mild — seal-like barking cough but no stridor or sternal/intercostal recession at rest.
    • Moderate — seal-like barking cough with stridor and sternal recession at rest; no (or little) agitation or lethargy.
    • Severe — seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
    • Impending respiratory failure — minimal barking cough, stridor may become harder to hear. Increasing upper airway obstruction, sternal/intercostal recession, asynchronous chest wall and abdominal movement, fatigue, pallor or cyanosis, decreased level of consciousness or tachycardia. The degree of chest wall recession may diminish with the onset of respiratory failure as the child tires. A respiratory rate of over 70 breaths/minute is also indicative of severe respiratory distress.
  • Consider differential diagnoses, such as epiglottitis and upper airway foreign body.
    • If epiglottitis is suspected, examination of the oropharynx or manipulation of the neck is contraindicated as it may precipitate further airway obstruction.

Basis for recommendation

These recommendations are based on expert opinion in review articles [Bjornson and Johnson, 2013; Johnson, 2016; Wright, 2016; BMJ, 2019].

What are the differential diagnoses of croup?

  • The differential diagnoses of croup include:
    • Bacterial tracheitis — may present with fever, sudden onset stridor, and respiratory distress, following a viral-like respiratory illness from which the person appears to be recovering but then becomes acutely worse.
    • Epiglottitis — may present with sudden onset high fever, dysphagia, drooling, anxiety, non-barking cough, and their preferred posture is sitting upright with head extended. Note: This is rarely seen since widespread immunisation against Haemophilus influenzae B.
    • Foreign body in upper airway — may present with sudden onset dyspnoea and stridor, usually a clear history of foreign body inhalation or ingestion, no prodrome or symptoms of viral illness, and no fever (unless secondary infection).
    • Retropharyngeal/peritonsillar abscess — may present with dysphagia, drooling, stridor (occasionally), dyspnoea, tachypnoea, neck stiffness, and unilateral cervical adenopathy. Onset is typically more gradual than with croup and is often accompanied by fever.
    • Angioneurotic oedema — may present with acute swelling of the upper airway that may cause dyspnoea and stridor. Fever is uncommon. Swelling of face, tongue, or pharynx may be present. Can occur at any age.
    • Allergic reaction — may present with rapid onset of dysphagia, stridor, and possible cutaneous manifestations (urticarial rash). Can occur at any age. Suspicion should be further raised if there is a personal or family history of prior episodes, or allergy. 

Basis for recommendation

The information on differential diagnoses of croup is based on expert opinion in review articles [Bjornson and Johnson, 2013; Johnson, 2016; Wright, 2016; BMJ, 2019].

Management

Scenario: Management

From age 3 months to 6 years.

How should I manage a child with croup?

  • Consider the need for hospital admission.
    • Admit all children with features of moderate or severe illness, or impending respiratory failure.
    • Consider hospital admission for children with a respiratory rate of over 60 breaths/minute or who have a high fever or 'toxic' appearance.
    • Also consider hospital admission for children with mild illness if there are factors that warrant a lower threshold for admission, such as:
      • Chronic lung disease (including bronchopulmonary dysplasia).
      • Haemodynamically significant congenital heart disease.
      • Neuromuscular disorders.
      • Immunodeficiency.
      • Age under three months.
      • Inadequate fluid intake (50 to 75% of usual volume, or no wet nappy for 12 hours).
      • Factors that might affect a carer's ability to look after a child with croup, such as adverse social circumstances, or concerns about the skill and confidence of the carer in looking after a child with croup at home, or the carer being able to spot deteriorating symptoms.
      • Longer distance to healthcare (in case of deterioration).
  • While awaiting admission to hospital:
    • Give controlled supplementary oxygen to all children with symptoms of severe illness or impending respiratory failure.
    • Administer a dose of oral dexamethasone (0.15 mg/kg). If the child is too unwell to receive medication, inhaled budesonide (2 mg nebulised as a single dose) or intramuscular dexamethasone (0.6 mg/kg as a single dose) are possible alternatives.
  • If hospital admission is not indicated (mild illness):
    • Prescribe a single dose of oral dexamethasone (0.15 mg/kg) to be taken immediately.
    • Advise the parents/carers:
      • On the expected course of croup, including that symptoms usually resolve within 48 hours. Patient information is available from www.nhs.uk.
      • To use paracetamol or ibuprofen for fever or pain. See the CKS topic on Analgesia - mild-to-moderate pain for prescribing information.
      • To encourage the child to take fluids regularly. For infants who are breastfed, advise continued breastfeeding.
      • To check on the child regularly, including through the night.
      • To take the child to hospital if stridor can be heard continually, the skin between the ribs is pulling in with every breath, and/or the child is restless or agitated.
    • Advise the parents/carers to call an ambulance if the child is:
      • Very pale, grey, or blue (including blue lips) for more than a few seconds.
      • Unusually sleepy or is unresponsive.
      • Having trouble breathing (for example, the belly is sinking in while breathing, or the skin between the ribs or over the windpipe is pulling in with each breath; the nostrils may also be flaring in and out).
      • Upset (agitated or restless) while struggling to breathe and cannot be calmed down quickly.
      • Unable to talk or is drooling, is having trouble swallowing, or want to sit instead of lie down.
    • Arrange follow up, using clinical judgment to determine the appropriate interval.

Basis for recommendation

These recommendations are largely based on trial evidence [Fernandes, 2014; Gates, 2018; Parker, 2019; Yang, 2022], expert opinion in the British National Formulary (BNF) [BNF, 2022] and in review articles [Bjornson and Johnson, 2013; Johnson, 2016; Wright, 2016; BMJ, 2019], and on what CKS considers to be good clinical practice.

Hospital admission
  • The recommendation to admit all children with features of moderate or severe illness, or impending respiratory failure is based on expert opinion that children in these groups require treatment with nebulised adrenaline, as well as corticosteroids [BMJ, 2019].
Factors that lower the threshold for hospital admission and respiratory rate
  • The information on factors that lower the threshold for hospital admission in children with croup, and respiratory rate as an indicator of illness severity is extrapolated from the National Institute of Health and Care Excellence (NICE) guideline Bronchiolitis in children: diagnosis and management [NICE, 2021]. 
Corticosteroid treatment
  • Efficacy and safety
    • Corticosteroids are an effective and established treatment for some acute respiratory infections, such as croup [Fernandes, 2014]. 
    • A Cochrane systematic review examined the effects of corticosteroids for the treatment of croup in children aged 0–18 years (43 studies, n = 4565) [Gates, 2018]:
      • The corticosteroids investigated included beclomethasone, betamethasone, budesonide, dexamethasone, fluticasone, and prednisolone. 
      • Three studies compared dexamethasone 0.6 mg/kg (the evidence-supported gold standard croup treatment) and dexamethasone 0.15 mg/kg.
      • The evidence showed that compared with placebo, corticosteroids reduced symptoms of croup at 2 hours and reduced the rate of re-presentation and readmission to healthcare services.
      • However, the reviewers could not determine the optimal type, dose, and route of administration of corticosteroids that is best for reducing symptoms of croup in children.
    • A systematic review and meta-analysis on the safety of corticosteroids in the treatment of acute respiratory disease in children found that corticosteroid use can significantly shorten hospitalization time and increase the cure rate without increasing adverse reactions [Yang, 2022].
    • No adverse effects have been attributed to the use of corticosteroids in children with croup. Theoretical concerns include a possible increased risk of complications of varicella (bacterial superinfection, disseminated varicella) in a child with recent exposure [BMJ, 2019].
  • Recommended dose of oral dexamethasone
    • Traditionally, a dose of 0.6 mg/kg/dose was used for croup; however, evidence now supports the use of a smaller dose of 0.15 mg/kg/dose [Johnson, 2016; BMJ, 2019; Parker, 2019].
    • The BNF recommends [BNF, 2022]:
      • For children with mild croup — one dose of oral dexamethasone 150 micrograms/kg.
      • For chidren with severe croup (or mild croup that might cause complications) — one dose of oral dexamethasone 150 micrograms/kg to be given before transfer to hospital. 
    • Expert opinion in a review article is that [BMJ, 2019]:
      • Alternative routes of administration will be necessary for some children, for example those with persistent vomiting or severe respiratory distress.
      • Inhaled budesonide may be preferable in children with severe hypoxia, in whom reduced gut and tissue perfusion can impair oral and intramuscular absorption.
      • Establishing intravenous (IV) access can increase distress and potentially precipitate respiratory failure. Extreme care should be taken when considering IV administration. 
Advice to parents/carers
  • These recommendations are largely based on the NICE guideline Fever in under 5s: assessment and initial management [NICE, 2019] and on what CKS considers to be good clinical practice.
  • The recommendation to check on the child regularly, including through the night is extrapolated from the NICE guideline Bronchiolitis in children: diagnosis and management [NICE, 2021]. 

Prescribing information

Important aspects of prescribing information relevant to primary healthcare are covered in this section specifically for the drugs recommended in this CKS topic. For further information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC), or the British National Formulary (BNF).

Budesonide and dexamethasone

Paracetamol and ibuprofen

Supporting evidence

This CKS topic is largely based on expert opinion in review articles [Bjornson and Johnson, 2013; Johnson, 2016; Wright, 2016; BMJ, 2019] and on what CKS considers to be good clinical practice. 

How this topic was developed

This section briefly describes the processes used in developing and updating this topic. Further details on the full process can be found in the About Us section and on the Clarity Informatics website.

Search strategy

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of croup.

Search dates

April 2017 - March 2022

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

  • exp Croup/, croup.tw., laryngotracheobronchitis.tw., laryngotracheitis.tw.

Sources of guidelines

Sources of systematic reviews and meta-analyses

  • The Cochrane Library:
    • Systematic reviews
    • Protocols
    • Database of Abstracts of Reviews of Effects
  • Medline (with systematic review filter)
  • EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

Sources of randomized controlled trials

  • The Cochrane Library:
    • Central Register of Controlled Trials
  • Medline (with randomized controlled trial filter)
  • EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Sources of national policy

Patient experiences

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

  • Clinical accuracy.
  • Consistency with other providers of clinical knowledge for primary care.
  • Accuracy of implementation of national guidance (in particular NICE guidelines).
  • Usability.

Principles of the consultation process

  • The process is inclusive and any individual may participate.
  • To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
  • Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
  • Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
  • External reviewers are not paid for commenting on the draft topics.
  • Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
  • All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
  • All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

  • Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
  • Stakeholders identified from the following groups are invited to review draft topics:
    • Experts in the topic area.
    • Professional organizations and societies (for example, Royal Colleges).
    • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
    • Guideline development groups where the topic is an implementation of a guideline.
    • The British National Formulary team.
    • The editorial team that develop MeReC Publications.
  • Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

  • Topic selection
  • Scoping of topic
  • Selection of clinical scenarios
  • First draft internal review
  • Second draft internal review
  • External review
  • Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

  • Animal studies
  • Original research is not written in English

Possible exclusions for reviewed literature:

  • Sample size too small or study underpowered
  • Bias evident or promotional literature
  • Population not relevant
  • Intervention/treatment not relevant
  • Outcomes not relevant
  • Outcomes have no clear evidence of clinical effectiveness
  • Setting not relevant
  • Not relevant to UK
  • Incorrect study type
  • Review article
  • Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

  • Feasibility
    • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
  • Organizational and Financial Impact Analysis
  • Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
    • Eligible population
    • Current interventions
    • Likely uptake of new intervention or recommendation
    • Cost of the current or new intervention mix
    • Impact on other costs
    • Condition-related costs
    • In-direct costs and service impacts
    • Time dependencies
  • Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

  • Personal financial interests
  • Personal family interest
  • Personal non-financial interest
  • Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.

References

  • Bjornson, C.L. and and Johnson, D.W. (2013) Croup in children. CMAJ 185(15), 1317-1323. [Abstract]
  • BMJ Best Practice (2019) Croup. BMJ Best Practice. https://bestpractice.bmj.com/info
  • BNF (2022) British National Formulary. National Institute for Health and Care Excellence. https://bnf.nice.org.uk
  • Denny, F.W., Murphy, T.F., Clyde, W.A Jr. et al. (1983) Croup: an 11-year study in a pediatric practice. Pediatrics 71(6), 871-876. [Abstract]
  • Fernandes, R.M., Oleszczuk, M., Woods, C.R. et al. (2014) The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: an overview of reviews. Evidence-Based Child Health 9(3), 733-747. [Abstract]
  • Gates, A., Gates, M., Vandermeer, B. et al. (2018) Glucocorticoids for croup in children (Cochrane Review/Cochrane Intervention Protocol). Issue 8. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
  • Johnson, D.W (2016) Croup. American Family Physician 94(6), 476-478. [Free Full-text]
  • NICE (2014) Fever in under 5s. QS64. National Institute for Health and Care Excellence. http://www.nice.org.uk [Free Full-text]
  • NICE (2019) Fever in under 5s: assessment and initial management. National Institute for Health and Care Excellence. www.nice.org.uk/ [Free Full-text]
  • NICE (2021) Bronchiolitis in children: diagnosis and management. NICE. NICE.org.uk. [Free Full-text]
  • Parker, C.M and Cooper, M.N (2019) Prednisolone Versus Dexamethasone for Croup: a Randomized Controlled Trial. Pediatrics 144(3), e20183772. [Abstract]
  • Wright, M. and Bush, A (2016) Assessment and management of viral croup in children. Prescriber 27(8), 32-37. [Free Full-text]
  • Yang, X. and Jin, H (2022) Safety of corticosteroids in the treatment of acute respiratory disease in children: a systematic review and meta-analysis. Translational pediatrics 11(2), 194-203. [Free Full-text]
Change privacy settings