Problem refinement

If swallowing is normal, this will point strongly to a diagnosis of croup, as this action is difficult in bacterial tracheitis. The mother reports no problems with the child’s swallowing. You are now confident he has mild to moderate croup. 

Red flags

A final check to rule out anaphylaxis should be made (e.g. checks for angioedema). His mother has not seen any swelling in and around the face.

Prescribing options

A single dose of dexamethasone could be given. If symptoms persist hospital admission should be arranged.

Safety netting

Mild croup can usually be managed at home with paracetamol for pain and to lower temperature with fever. Referral to a GP for a corticosteroid might be necessary in more severe cases or if the child’s symptoms worsen. In very severe cases hospital treatment may be required.