An international panel of otolaryngologists and respiratory specialists used a modified Delphi process, informed by a review of 28 studies, to agree how to evaluate and manage recurrent croup in children. The literature was heterogeneous and mostly at moderate to high risk of bias, which is why consensus was needed.
There was strong agreement that direct laryngoscopy and bronchoscopy should be prioritised in atypical presentations, including sizing the subglottis and excluding a laryngeal cleft, and that allergy testing should be limited to children with clinical features of atopy. The panel also agreed on joint ENT and respiratory management, avoiding routine imaging, and reserving advanced reflux investigation for refractory cases.
The panel could not agree on empirical inhaled corticosteroids or antireflux medication, which remain common in practice without clear evidence.
This is consensus, not trial evidence, but it gives a structure for a condition where practice varies widely. In India, where access to paediatric airway endoscopy is concentrated in larger centres, it supports referring atypical cases rather than repeated imaging and empirical treatment.
- Consider direct laryngoscopy and bronchoscopy for children with atypical recurrent croup.
- Size the subglottis and look for a laryngeal cleft at endoscopy.
- Avoid routine neck or chest imaging for recurrent croup.
- Limit allergy testing to children with clinical signs of atopy.
- Manage jointly with paediatric respiratory colleagues.
Why it matters
It replaces a patchwork of local habits with a shared starting point for referral and investigation.
Don't overread it
Expert consensus built on low-quality studies; it does not show endoscopy improves outcomes.
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