🫁 Croup vs Epiglottitis
A barking cough or a drooling child sitting forward. One goes home; the other needs a surgeon and nothing in the mouth.
⚖️ Telling them apart
Children have narrow airways, so a small amount of swelling causes a large obstruction. These two are the classic pair, and confusing them is dangerous.
| CROUP | EPIGLOTTITIS | |
|---|---|---|
| Cause | Viral (parainfluenza) | Bacterial — H. influenzae type b |
| Onset | Gradual, often at night | Sudden, over hours |
| Cough | Barking, seal-like | NONE |
| Voice | Hoarse | Muffled, “hot potato” |
| Drooling | No | YES — cannot swallow |
| Position | Any | Tripod, leaning forward, chin out |
| Fever | Low grade | High, over 39°C |
| Appearance | Unwell but interactive | Toxic, anxious, still |
| Treatment | Cool mist, steroids, nebulized epinephrine. Often home | Emergency airway in theater; IV antibiotics |
⭐ The 4 Ds of epiglottitis
Drooling · Dysphagia · Dysphonia · Distress
A child who is drooling, sitting forward and will not talk is epiglottitis until proven otherwise.
🚨 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 airway. Any of them can trigger complete airway obstruction.
Do not lie the child down either. Keep them upright, calm and with a parent.
Why keeping them calm is a clinical intervention: crying and struggling increase airflow turbulence through an already swollen airway and can close it completely. Letting the parent hold the child is treatment, not kindness.
✅ Prevention
The Hib vaccine has made epiglottitis rare — given from 2 months. It is one of vaccination’s clearest success stories, and worth saying to hesitant parents.
🩺 Croup care
- Cool mist or cool night air — many children improve on the drive to hospital
- Corticosteroids (dexamethasone) reduce airway edema
- Nebulized epinephrine for moderate to severe stridor; observe afterwards for rebound
- Fluids; keep the child calm — same principle as above
- Most are managed at home
No sedatives - they mask the signs of worsening respiratory distress.
🚨 When croup needs hospital
- Stridor at rest, not just when upset
- Retractions that are worsening
- Restlessness or drowsiness — hypoxia
- Cyanosis; rising respiratory rate then a falling one as they tire
A quiet, floppy child is more worrying than a screaming one. Silence in respiratory distress means exhaustion.
🎯 NCLEX traps
- Barking cough = croup. Drooling + tripod + no cough = epiglottitis
- Nothing in the mouth with epiglottitis
- Keep the child upright and calm with the parent
- Croup gets cool mist and steroids; epiglottitis gets theater and antibiotics
- No sedatives in either
- Hib vaccine prevents epiglottitis