Chart 1. Clinical manifestations, differential diagnosis, and management recommendations of croup in children.

MANIFESTATIONS AND DIFFERENTIAL DIAGNOSIS
Etiology	Age range	CLINICAL MANIFESTATIONS
Croup	6 months to 3 years	Acute onset of barking cough, stridor, and hoarseness
Bacterial tracheitis	< 6 years	High fever, barking cough, respiratory distress, and rapid deterioration
Congenital or acquired airway lesions	< 6 months to 4.5 years	Recurrent episodes of barking cough and stridor
Foreign body aspiration	< 3 years	Acute onset of choking and/or drooling
Hemangioma	< 6 months	Stridor worse with crying
Laryngomalacia	< 18-24 months	Stridor that worsens with crying and feeding. Symptoms related to position.
Neoplasm	No age predilection	Progressive airway symptoms
Retropharyngeal, parapharyngeal, peritonsillar abscesses	6 months to 35 years	High fever, neck pain, sore throat, and dysphagia followed by torticollis, drooling, and stridor
MANAGEMENT
ACUTE MANAGEMENT	• Corticosteroids administered orally, inhaled, or intramuscularly • Nebulized epinephrine may be recommended for moderate to severe airway obstruction
RECURRENT CROUP MANAGEMENT	• Endoscopic airway evaluation may help identification of underlying airway disorder • In the acute management of recurrent croup, patients may receive the standard treatment above >• Inhaled steroids may be used to reduce recurrence