Croup

Definition
Croup, also known as laryngotracheal bronchitis, is a common childhood infection. The classic symptom is a sudden, barking cough.

Causes/associated factors
Croup is typically caused by a virus. As the virus causes swelling and inflammation of the larynx (vocal cord) and trachea (windpipe), the breathing passage narrows. This narrowing causes a barking cough and noisy breathing that progressively worsens, especially at night, in the early morning or when the child is upset.
Croup is most common in the fall and winter (typically between October and March). It often develops a few days after an upper respiratory infection, and recurrences are common. Children between ages 3 months and 5 years are affected most often, and boys are twice as likely to develop croup as girls. The incidence decreases as children get older due to their growing airways.


Transmission
The viruses responsible for croup are easily passed among children through infected respiratory droplets sneezed or coughed into the air or by touching objects soiled with respiratory droplets.

Signs/symptoms
Croup symptoms may develop gradually or suddenly, often after a few days of cold symptoms. Common symptoms include:
sudden onset of harsh, tight, brassy cough that sounds like the bark of a seal; the cough often appears during the night
noisy, difficult breathing
hoarseness
low-grade fever
These symptoms are typically worse during the first one to three days, followed by improvement over several days.

More serious symptoms that may require emergency treatment include:

labored breathing or increased difficulty breathing
high-pitched noises when breathing in
drooling
retractions (The skin sinks between, above or below the ribs.)
nasal flaring (The nostrils flare out when breathing in.)
blue tinge to the lips or nail beds
paleness
restlessness
change in consciousness level

Diagnosis
The doctor will ask questions about the child's medical history and the current cough pattern, and do a physical exam.

Treatment
Croup usually lasts a few days, but on rare occasions it may last for weeks. Mild cases can typically be treated at home. Your doctor may offer the following suggestions.
Create a humid environment. Take your child into the bathroom, close the door, and turn on the hot water in the sink and shower. The moist air should help the breathing within 10 to 20 minutes.

At night, run a cool mist humidifier near your child's bed.

If it's cool outdoors, open a few windows to let in the fresh air. It may also help to take your child outdoors in the cool night air.

Provide a soothing atmosphere. Crying and agitation make it more difficult to breathe.

Help your child find a comfortable position. Breathing is often easiest when sitting up. Babies can be kept in infant seats.

Limit your child's activity. Keep your child home from school or day care until any fever is gone and appetite and energy levels return to normal.

Encourage your child to drink liquids.

Avoid exposure to tobacco smoke and other respiratory irritants, such as air pollution, dust and fumes.

Stay with your child to monitor symptoms.
Oral or injectable steroids (such as prednisone or dexamethasone) may help reduce the severity of symptoms and speed improvement in moderate to severe cases of croup. Antibiotics are typically not helpful because croup is caused by a virus. Cough suppressants may not help either, and can actually prevent your child from coughing out mucus.

If left untreated, severe cases of croup can lead to complete airway obstruction. This is a medical emergency that requires immediate medical treatment.

If your child's symptoms worsen or a coughing attack lasts more than 10 minutes, call the doctor or take your child to the emergency room. If hospitalization is necessary, your child may be given medications, such as steroids or nebulized epinephrine, to reduce airway inflammation. If throat swelling remains severe, your child may need the help of a ventilator to breathe.


Complications
A few children who have croup develop complications. The infection can spread to other parts of the body, such as the middle ear or lungs. Dehydration can develop if your child is unable to drink enough fluids. If breathing difficulty is severe, temporary mechanical ventilation is typically enough to help with breathing. Rarely, a surgical procedure called a tracheotomy (creating a new airway by making an incision into the trachea at the front of the neck) is needed.

Prevention
Respiratory illnesses are difficult to prevent, especially during seasons when much time is spent in close quarters indoors. Keep your child's immune system strong with healthful meals and proper rest. To keep throat tissues moist, encourage your child to drink plenty of water and juice.