🫁 Croup vs Epiglottitis
A barking cough or a drooling child sitting forward. One is managed at home; the other is an airway emergency where you put nothing in the mouth.
⚖️ The comparison
Children have narrow airways, so a small amount of swelling causes big obstruction. These two look similar at first and are managed completely differently.
| CROUP (laryngotracheobronchitis) | EPIGLOTTITIS | |
|---|---|---|
| Cause | Viral | Bacterial — H. influenzae type b |
| Onset | Gradual, often worse at night | Sudden — hours |
| Cough | Barking, seal-like | NONE |
| Fever | Low grade | High — over 102°F |
| Signature | Inspiratory stridor, hoarse voice | 4 Ds — Drooling, Dysphagia, Dysphonia, Distress |
| Position | Any | Tripod — sitting forward, chin out |
| Treatment | Cool mist, steroids, nebulized epinephrine | Emergency airway — theater |
| Managed at home? | Often yes | Never |
Drooling is the giveaway. A child drooling because it hurts too much to swallow, sitting forward to keep the airway open, with a muffled voice and no cough — that is epiglottitis.
🚨 The single most important rule
In suspected epiglottitis, put NOTHING in the child's mouth. No tongue depressor, no throat swab, no oral thermometer, no oral fluids.
The epiglottis is swollen and inflamed. Touching it can cause complete airway obstruction within seconds.
Crying worsens obstruction. Everything you do — letting the parent hold them, avoiding needles until the airway is secure, keeping the room calm — exists to stop the child crying.
Signs a tracheostomy may be needed: increasing restlessness, rising heart rate, worsening retractions.
💉 Prevention
The Hib vaccine has made epiglottitis rare. Every child from 2 months should receive it. An unvaccinated child with these signs raises the suspicion considerably.
🩺 Croup care
- Cool mist or humidified air — the classic home measure. Sitting in a steamy bathroom, or taking the child into cool night air, often helps within minutes
- Dexamethasone reduces airway edema
- Nebulized epinephrine for moderate to severe stridor — watch for rebound as it wears off
- Keep the child calm and upright; fluids to keep hydrated
- Antipyretics for comfort
Antibiotics do not help croup - it is viral. They are essential in epiglottitis.
🚨 When croup needs to be seen
- Stridor at rest rather than only when upset
- Retractions, nasal flaring
- Cyanosis or pallor
- Restlessness, or unusual quietness — both signal hypoxia
- Drooling or inability to swallow — reconsider epiglottitis
Never give sedatives to a child with croup. They mask the very signs of deterioration you are watching for.
🎯 NCLEX traps
- Barking cough = croup. Drooling + tripod + no cough = epiglottitis
- Nothing in the mouth with epiglottitis — the single most tested rule
- Keep the child calm and with the parent; crying worsens obstruction
- No sedatives in croup
- Hib vaccine prevents epiglottitis