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March 1990

Management of Croup

Author Affiliations

Pediatric Otolaryngology Children's Hospital Medical Center Elland and Bethesda avenues Cincinnati, OH 45220-2899

Am J Dis Child. 1990;144(3):267. doi:10.1001/archpedi.1990.02150270013005

Sir.—We read with interest the article in the September 1989 issue of AJDC by Skolnik.1 This article purports "to critically review and synthesize the complete body of English-language literature on the medical treatment of croup and formulate a set of recommendations to guide physicians in making treatment decisions for children with croup who require hospitalization." Unfortunately, the article is woefully lacking in terms of management decisions that must be made in some critically ill children with croup. From the outset, Dr Skolnik misrepresents the true nature of the disease entity. He defines croup as a syndrome of laryngeal obstruction when, in fact, it is generally recognized to be a diffuse inflammatory condition of the larynx, trachea, and bronchi. In many circles, the term laryngotracheobronchitis is much preferred to the term croup. In his review, Dr Skolnik tends to neglect the tracheal and bronchial involvement that many times complicate