croup

Croup is a condition that causes an inflammation of the upper airways — the voice box (larynx) and windpipe (trachea). It often leads to a barking cough or hoarseness , especially when a child cries.

Most cases of croup are caused by viruses. Those involved are usually para influenza virus (which accounts for most cases),adenovirus, and respiratory syncytial virus(RSV). Croup is most common — and symptoms are most severe — in children 6 months to 3 years old, but can affect older kids, too.

Most cases of viral croup are mild and can be treated at home, though rarely it can be severe and even life-threatening. Some children are more prone to developing croup when they get a viral upper respiratory infection

Croup Symptoms

The infection starts with a cold,cough, and low-grade temperature. Symptoms gradually develop over two days. The typical barking cough is usually present by day three and is more likely to be worse at night. The presence of stridor (wheezing on inspiration),hoarseness, difficulty swallowing, and respiratory distress are common but may or may not be severe.

croup, also called laryngotracheobronchitis, most commonly affects children between the ages of six months and three years, usually during the late fall, winter and early spring. Symptoms, which often include a runny nose and a brassy cough, develop about 2-6 days after being exposed to someone with croup.

One of the distinctive characteristics of croup is the abrupt or sudden onset of symptoms. Children will usually be well when they went to bed, and will then wake up in the middle of the night with a croupy cough and trouble breathing. The cough that children with croup have is also distinctive. Unlike other viral respiratory illnesses, which can cause a dry, wet, or deep cough, croup causes a cough that sounds like a barking seal.

Croup Treatment

Self-Care at Home

Consider substituting water or juice for milk products. Frequent sips of clear liquids can loosen mucus and prevent dehydration, which often occurs with croup.

Crying can trigger spasmodic coughing. Attempt to comfort your child to prevent agitation.

Acetaminophen (Children’s Tylenol) or ibuprofen (Advil, Motrin) may be given for fever or sore throat. Aspirin-containing medications should never be given to children unless prescribed by a physician due to the risk of a serious liver condition called Reye syndrome.

Over-the-counter cough medications are not routinely recommended. Avoid exposure to respiratory irritants such as smoke.

Treatment

Children with moderate or severe croup, or who aren’t quickly responding to home treatments, will need medical attention for further treatments, which usually includes administering a steroid to help decrease swelling and inflammation and improve breathing. An injection of dexamethasone has been the standard way of administering this steroid, but new studies have shown that an oral steroid (Prelone, Orapred, etc) or steroid delivered by a nebulizer (Pulmicort) may also be effective.

For children with severe respiratory distress, treatment, in a hospital setting may include a breathing treatment with racemic epinephrine. Because there is a risk of a ‘rebound’ and worsening breathing, children are usually observed for 2-4 hours after receiving racemic epinephrine. Children who continue to have difficulty breathing, or who require more than one treatment, are usually hospitalized.

A mist or oxygen tent has long been used to treat children who are hospitalized, but there use has been decreased because it makes it harder for the hospital staff to observe the child and notice if he is getting worse. Instead, blow by oxygen or cool mist may be used.

A newer treatment that is being researched is the use of a helium-oxygen mixture for children with severe croup.

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