Most croup is viral, self-limiting and needs no investigation. Features that should prompt ENT referral for airway assessment include onset in the first months of life, episodes without a viral prodrome, persistent stridor between episodes, a history of prolonged intubation, failure to respond to steroids, and associated feeding difficulty or aspiration. These point towards subglottic stenosis, a haemangioma, a laryngeal cleft or another structural cause.
- Refer infants with croup in the first months of life.
- Refer when stridor persists between episodes.
- Ask about previous intubation and feeding or aspiration problems.
- Note episodes that do not follow a cold or do not respond to steroids.
Why it matters
Structural airway problems hide behind a common diagnosis.
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