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Croup


Alternative names

Viral croup; Laryngotracheobronchitis - acute; Spasmodic croup

Definition

Croup is breathing difficulty accompanied by a "barking" cough. Croup is common in infants and children and can have a variety of causes. Viral croup is the most common.

Causes, incidence, and risk factors

The word croup comes from an old German word for the voice box and refers to swelling around the vocal cords. Viruses, bacteria, allergies, and inhaled irritants can cause croup. Acid reflux from the stomach can trigger croup.

Croup is usually (75 percent of the time) caused by parainfluenza viruses, but RSV, measles, adenovirus, andinfluenzacan all cause croup.

Before the era of immunizations and antibiotics, croup was a dreaded and deadly disease, usually caused by the diphtheria bacteria. Today, most cases of croup are mild. Nevertheless, it can still be dangerous.

Croup tends to appear in children between 3 months and 5 years old, but it can happen at any age. Some children are prone to croup and may get it several times.

In the Northern hemisphere, it is most common between October and March, but can occur at any time of the year.

In severe cases of croup, there may also be a bacterial super-infection of the upper airway. This condition is called bacterial tracheitis and requires hospitalization and intravenous antibiotics. If the epiglottis becomes infected, the entire windpipe can swell shut, a potentially fatal condition called epiglottitis .

Symptoms

Croup features a cough that sounds like a seal barking. Most children have what appears to be a mild cold for several days before the barking cough becomes evident. As the cough gets more frequent, the child may have labored breathing or stridor (a harsh, crowing noise made during inspiration).

Signs and tests

Children with croup are usually diagnosed based on the parent's description of the symptoms and a physical exam. Sometimes a doctor will even identify croup by listening to a child cough over the phone. Occasionally other studies, such as x-rays, are needed.

Treatment

Most cases of croup can be safely managed at home, but call your healthcare provider for guidance, even in the middle of the night.

Home therapy usually consists of a mist treatment. A cool air nebulizer is best, but hot steam from a shower in a closed bathroom can be used. Sometimes stepping outside into the cool night air does the trick.

Acetaminophen can make the child more comfortable and lower a fever, lessening his or her breathing needs. Avoid cough medicines unless you discuss them with your doctor first.

You may want your child to be seen. Steroid medicines can be very effective at promptly relieving the symptoms of croup. Medicated aerosol treatments, if necessary, are also powerful.

Serious illness requires hospitalization. Increasing or persistent breathing difficulty , fatigue , bluish coloration of the skin , or dehydration indicates the need for medical attention or hospitalization.

Aerosolized racemic epinephrine as well as oral dexamethasone (a steroid) are used to help to shrink the upper airway swelling. Oxygen and humidity may be provided in an oxygen tent placed over a crib. A bacterial infection requires antibiotic therapy.

Increasing obstruction of the airway requires intubation (placing a tube through the nose or mouth through the larynx into the main air passage to the lungs). Intravenous fluids are given for dehydration. In some cases, corticosteroids are prescribed.

Expectations (prognosis)

Viral croup usually goes away in 3 to 7 days. The outlook for bacterial croup is good with prompt treatment.

If an airway obstruction is not treated promptly, respiratory distress (severe difficulty breathing) and respiratory arrest can occur.

Complications

  • Respiratory distress
  • Respiratory arrest
  • Epiglottitis
  • Bacterial tracheitis
  • Atelectasis (collapse of part of the lung)
  • Dehydration

Calling your health care provider

Most croup can be safely managed at home with telephone support from your health care provider. Children should be seen immediately for any of the following:

  • Stridor (noise when breathing in)
  • Retractions (tugging-in between the ribs when breathing in)
  • Dusky lips or bluish skin color

    Prevention

    Wash your hands frequently and avoid close contact with people with respiratory infections to avoid spreading the viruses.

    The diphtheria, Haemophilus influenzae (Hib)

    Update Date: 10/29/2003

    Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Stanford School of Medicine; Lucile Packard Children's Hospital; Chief Medical Officer, A.D.A.M., Inc.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT
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