worst, and then the child starts to improve. Children who do not follow this general course should be reevaluated.

Viral croup is classically associated with biphasic stridor, although often the inspiratory component is much greater than the expiratory component. Stridor is unaffected by position but increases with crying or agitation. Intercostal retractions and tachypnea are common signs. The voice is often hoarse but not muffled. If inflammation extends from the trachea to the more distal bronchi, wheezing or crackles will be present.

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