Croup

Case 1 A 20-month-old boy is brought to his family practitioner by his mother. The boy has a 12-hour history of a loud cough, slight fever to 101°F, and a hoarse voice. The mother reports that the child had a difficult time sleeping the previous night because of the harsh cough. On examination, the boy is playful and smiling with a temperature of 99°F. It is noticed that he has a seal-like barking cough and subtle evidence of audible stridor.His chest is clear on auscultation with a normal respiratory rate.No chest wall recession is noted. The rest of the exam is unremarkable. The patient is sent home with a suspected upper respiratory infection. Later that evening, the family practitioner receives a phone call from the emergency department informing him that the patient has had worsening respiratory difficulty with visible signs of inspiratory stridor and is being admitted to the hospital for further observation.