What criteria should I use to determine if a child with croup requires hospital admission?

Criteria for hospital admission in children with croup include:

• Presence of moderate or severe illness features, or signs of impending respiratory failure, which necessitate admission for treatments such as nebulised adrenaline and corticosteroids.
• A respiratory rate over 60 breaths per minute.
• High fever or a 'toxic' appearance.
• Children with mild illness but with risk factors that lower the threshold for admission, including:
• 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 affecting the carer's ability to manage the child at home, such as adverse social circumstances, lack of skill or confidence in spotting deterioration, or long distance to healthcare facilities.

While awaiting admission, children with severe illness or impending respiratory failure should receive controlled supplementary oxygen and corticosteroid treatment (oral dexamethasone 0.15 mg/kg or alternatives if oral administration is not possible).

Children without these criteria and with mild illness can be managed at home with a single dose of oral dexamethasone and appropriate parental advice.

NICE CKS