Introduction

A 2-year-old child is brought to the emergency department with a barking cough, subcostal recessions and intermittent stridor. Concerned about the symptoms, their parents are asking for the best possible treatment to improve the symptoms and reduce the need for further treatment or admission.

In any child presenting with stridor, it is important to consider a wide range of differentials (table 1).1 Croup (also called laryngotracheitis) is a common cause of stridor and upper airway obstruction in children aged 6–36 months.2 Croup usually occurs in the winter months and is most frequently caused by human parainfluenza virus types 1 and 2; less commonly, other respiratory viruses, such as respiratory syncytial virus, can also cause croup.2 Recently, SARS-CoV-2 has emerged as a cause and can often occur in an older demographic of children.3–6 Research involving large cohorts of children with croup has demonstrated that only a small proportion require hospital admission.1 6 Therefore, the mainstay of treatment is oral corticosteroids in the emergency department and discharge with an appropriate safety net.2 7 It is important to note that recent studies involving children with SARS-CoV-2 and croup have observed a more severe illness, a greater requirement for epinephrine and a greater need for intensive care.3–6 8 As such, although the treatment is the same, clinicians should be mindful of the probability of a more severe illness when treating children with COVID-19 and croup.3–6 8

The Westley Croup Score (table 2) is a standardised scoring …