Chart — Neonatal & Pediatric
Croup vs Epiglottitis
Both croup and epiglottitis cause stridor in a child, but one is a common viral illness and the other is an airway emergency. This grid lines up the discriminating features so the two are never confused. The fastest tells: a barking cough favors croup, while a toxic, drooling child sitting forward with no cough is epiglottitis until proven otherwise.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
The Comparison
| Feature | Croup (viral) | Epiglottitis (bacterial) |
|---|---|---|
| Cause | Parainfluenza and other viruses | Bacterial (classically Haemophilus influenzae type b; now rare with Hib vaccine) |
| Site | Subglottic (below the cords) | Supraglottic (the epiglottis) |
| Typical age | ~6 months to 3 years | ~2 to 7 years (any age now) |
| Onset | Gradual, viral prodrome, worse at night | Rapid (hours), toxic |
| Fever | Low-grade | High |
| Cough | Barking, seal-like | Absent (typically no cough) |
| Voice | Hoarse | Muffled (“hot potato”) |
| Drooling / dysphagia | No | Yes (cannot swallow secretions) |
| Posture | Variable | Tripod, sitting forward, sniffing |
| Appearance | Nontoxic, alert | Toxic, anxious, very still |
| Stridor | Inspiratory | Inspiratory, often softer (ominous when quiet) |
| Classic X-ray sign | “Steeple sign” (AP neck, subglottic narrowing) | “Thumb sign” (lateral neck, swollen epiglottis) |
| Management | Dexamethasone; racemic epinephrine if moderate-severe; supportive | Keep calm, do NOT examine the throat, secure the airway in a controlled setting (OR), IV antibiotics - an emergency |
How to Use This Chart
- The quickest discriminators: a barking cough favors croup; drooling plus a toxic, tripoding child with no cough is epiglottitis until proven otherwise.
- Do not agitate or examine the throat of a child with suspected epiglottitis — prepare for a controlled airway instead.
- A child with worsening obstruction may have a quieter stridor as airflow falls — quieter is not better.
Related Resources
Sources
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. Pediatric upper airway disorders chapters.
- Bjornson CL, Johnson DW. Croup in children. CMAJ. 2013;185(15):1317-1323.