What are the distinctive symptoms of croup in children. How can croup be treated at home. When should parents seek immediate medical attention for a child with croup.

Understanding Croup: A Common Childhood Condition

Croup is a childhood respiratory condition that affects the windpipe (trachea), airways to the lungs (bronchi), and voice box (larynx). This ailment is characterized by its distinctive symptoms and primarily impacts young children. But what exactly causes croup, and how does it manifest?

Croup is typically caused by a viral infection, with the parainfluenza virus being the most common culprit. The infection leads to inflammation and swelling of the upper airway, resulting in the characteristic symptoms associated with the condition.

Who is most susceptible to croup?

Croup predominantly affects children between the ages of six months and three years, with the highest incidence occurring in one-year-olds. However, it’s important to note that the condition can also develop in:

• Babies as young as three months
• Older children up to 15 years of age
• Adults (although this is rare)

Interestingly, croup tends to be more prevalent during the late autumn and early winter months. It also appears to affect more boys than girls, though the reasons for this gender disparity are not entirely clear.

Recognizing the Telltale Signs of Croup

Identifying croup early can lead to prompt treatment and better outcomes. But how can parents recognize the symptoms of croup in their children?

Key symptoms of croup include:

• A distinctive barking cough, often described as sounding like a seal’s bark
• A harsh, raspy sound (stridor) when breathing in
• Hoarseness of voice
• Difficulty breathing due to airway obstruction

These symptoms often worsen at night and can be exacerbated by crying or agitation. It’s crucial for parents to remain calm, as their anxiety can further distress the child and potentially worsen the symptoms.

Home Management of Croup: Effective Strategies for Parents

Most cases of croup are mild and can be effectively managed at home. How can parents alleviate their child’s discomfort and support their recovery?

Key strategies for managing croup at home include:

1. Sitting the child upright to ease breathing
2. Comforting the child to reduce distress
3. Ensuring adequate fluid intake to prevent dehydration
4. Using a cool-mist humidifier to moisten the air
5. Encouraging rest to support the body’s healing process

In addition to these home remedies, a healthcare provider may prescribe a single dose of an oral corticosteroid medication, such as dexamethasone or prednisolone. These medications help reduce throat swelling and alleviate symptoms.

When to Seek Immediate Medical Attention

While most cases of croup can be managed at home, there are situations where immediate medical attention is necessary. How can parents identify when their child’s condition requires emergency care?

Seek immediate medical help if your child:

• Has severe breathing difficulties
• Shows an increased breathing rate (too breathless to feed or talk)
• Has a ‘silent chest’ (inability to hear breathing sounds)
• Exhibits a worsening cough or rasping sound
• Shows signs of distress and agitation
• Has dark, blue-tinged, or pale skin
• Displays visible pulling and tightening of the skin around the ribs and chest
• Shows abnormal drowsiness or sleepiness
• Is unable to drink fluids

In these cases, it’s crucial to take the child to the emergency department or call for an ambulance immediately. Prompt medical intervention can prevent potential complications and ensure the child receives appropriate care.

Medical Treatment Options for Severe Croup

In cases where home management is insufficient, or when a child presents with severe symptoms, hospital treatment may be necessary. But what does medical treatment for severe croup entail?

Hospital treatment for severe croup may include:

• Administration of adrenaline via a nebulizer to reduce airway inflammation
• Oxygen therapy to support breathing
• Intravenous fluids if the child is dehydrated
• Continuous monitoring of the child’s condition

These interventions aim to stabilize the child’s condition, improve breathing, and prevent complications. The duration of hospital stay varies depending on the severity of the symptoms and the child’s response to treatment.

Potential Complications of Croup: What Parents Should Know

While most cases of croup resolve without issues, complications can occur in some instances. What are the potential complications of croup, and how common are they?

Possible complications of croup include:

• Pneumonia
• Middle ear infection
• Dehydration
• Respiratory failure (in rare, severe cases)

It’s important to note that these complications are rare, especially when croup is promptly and appropriately managed. The vast majority of children recover fully from croup within a few days to a week, without any long-term effects.

Preventing Croup: Challenges and Best Practices

Given that croup is typically caused by viral infections, prevention can be challenging. However, there are steps parents can take to reduce the risk of their child contracting or spreading the infection.

Strategies for preventing croup include:

1. Practicing good hand hygiene
2. Teaching children to cover their mouth and nose when coughing or sneezing
3. Avoiding close contact with individuals who have respiratory infections
4. Keeping children’s vaccinations up to date
5. Maintaining a clean living environment

While these measures can help reduce the risk, it’s important to remember that complete prevention of croup is not always possible due to the prevalence of the viruses that cause it.

Long-term Outlook: Recurrence and Future Health Implications

Parents often wonder about the long-term implications of croup and whether their child is likely to experience recurrent episodes. What can families expect in terms of croup recurrence and long-term health outcomes?

Key points about the long-term outlook for children who have had croup:

• Some children may experience croup more than once during childhood
• Recurrent croup is not uncommon, especially in children with a history of allergies or asthma
• Most children outgrow their susceptibility to croup as they get older
• There are typically no long-term health implications from having croup

It’s reassuring for parents to know that while croup can be distressing in the moment, it generally doesn’t lead to lasting health problems. However, children with recurrent croup may benefit from follow-up with a pediatrician to rule out any underlying conditions.

Supporting Your Child Through Croup: Emotional and Practical Considerations

Dealing with croup can be stressful for both children and parents. How can families navigate this challenging time while providing the best possible care and support?

Tips for supporting a child with croup:

1. Stay calm and reassuring to help keep the child relaxed
2. Create a soothing environment, perhaps with quiet activities or gentle music
3. Offer frequent small sips of water or clear fluids to prevent dehydration
4. Use distraction techniques to take the child’s mind off their discomfort
5. Ensure other family members understand the situation and how they can help

Remember, your calm presence can significantly impact your child’s experience with croup. By staying informed and prepared, you can help your child navigate this common childhood illness with confidence and care.

Croup in Different Age Groups: Variations in Presentation and Management

While croup predominantly affects young children, its presentation and management can vary across different age groups. How does croup manifest in infants, older children, and the rare cases in adults?

Croup in infants (under 1 year):

• May present with more severe symptoms due to smaller airways
• Often requires closer monitoring and more frequent medical assessment
• May need hospitalization more frequently than older children

Croup in older children (3-15 years):

• Generally milder symptoms due to larger airways
• May be more able to communicate their discomfort, aiding in assessment
• Often manageable at home with appropriate care and medication

Croup in adults (rare cases):

• Can occur but is extremely uncommon
• May be associated with other underlying health conditions
• Often requires medical evaluation to rule out other causes of similar symptoms

Understanding these age-related differences can help in recognizing and managing croup appropriately across different life stages. It’s always advisable to consult with a healthcare provider for personalized advice based on the individual’s age and specific symptoms.

The Role of Medications in Managing Croup

While many cases of croup can be managed with supportive care at home, medications play a crucial role in more severe cases or when symptoms are particularly distressing. What medications are commonly used in the treatment of croup, and how do they work?

Common medications used in croup management:

1. Corticosteroids (e.g., dexamethasone, prednisolone):
   • Reduce inflammation in the airway
   • Often given as a single oral dose
   • Can provide relief within hours and effects last for several days
2. Epinephrine (adrenaline):
   • Used in severe cases or when rapid symptom relief is needed
   • Administered via nebulizer in a hospital setting
   • Works quickly to reduce airway swelling but effects are short-lived
3. Over-the-counter pain relievers (e.g., acetaminophen, ibuprofen):
   • Can help reduce fever and discomfort
   • Should be used as directed by a healthcare provider

It’s important to note that antibiotics are not effective against croup as it’s typically caused by viruses. The use of medications should always be under the guidance of a healthcare professional, taking into account the child’s age, overall health, and severity of symptoms.

Croup and Its Impact on Family Life

The sudden onset and distinctive symptoms of croup can significantly impact family life, especially during the acute phase of the illness. How can families navigate the challenges posed by croup while maintaining a sense of normalcy?

Strategies for managing family life during a croup episode:

• Communicate openly with family members about the condition and what to expect
• Adjust sleep arrangements if necessary to allow for better monitoring of the affected child
• Plan for potential disruptions to work or school schedules
• Ensure other children in the family understand the situation and feel supported
• Consider enlisting help from extended family or friends if needed
• Practice self-care for parents and caregivers to manage stress and fatigue

Remember, while croup can be challenging in the short term, it’s typically a self-limiting condition. Maintaining a positive outlook and focusing on supporting each other can help families navigate this temporary disruption more smoothly.

Advances in Croup Research: Current Understanding and Future Directions

Medical understanding of croup has evolved significantly over the years, leading to improved management strategies. What are the latest developments in croup research, and what potential advancements might we see in the future?

Recent advances in croup research include:

1. Better understanding of the viral causes of croup, including the role of newly identified viruses
2. Improved diagnostic techniques, including the use of ultrasound to assess airway narrowing
3. Refinement of treatment protocols, optimizing the use of corticosteroids and other medications
4. Exploration of potential preventive strategies, including vaccine development for common croup-causing viruses

Future research directions may focus on:

• Developing more targeted therapies to address specific viral causes of croup
• Investigating genetic factors that may predispose some children to recurrent croup
• Exploring novel drug delivery methods for more effective treatment
• Enhancing prediction models to identify children at higher risk of severe croup

These ongoing research efforts aim to further improve our understanding of croup, leading to even more effective prevention and treatment strategies in the future. As our knowledge expands, we can hope for continued advancements in managing this common childhood condition.

Croup | NHS inform

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About croup

Croup is a childhood condition that affects the windpipe (trachea), the airways to the lungs (the bronchi) and the voice box (larynx).

Children with croup have a distinctive barking cough and will make a harsh sound, known as stridor, when they breathe in.

They may also have a hoarse voice and find it difficult to breathe because their airway is blocked.

Immediate action required:

Take your child to A&E or phone 999 if your child:

• has severe breathing difficulties
• has an increased breathing rate (they’re too breathless to feed or talk) or ‘silent chest’ (you’re unable to hear sounds of breathing)
• has a worsening cough or rasping sound
• shows distress and agitation
• has dark, blue-tinged or pale skin
• the skin around their ribs and chest appears to be pulled in and tight, making the bones of their chest and ribs more visible
• has abnormal drowsiness and sleepiness
• has an inability to drink fluids

Urgent advice:

Contact your GP or, if your GP’s closed, phone 111 if:

• is less than 3 months old and has a temperature of 38 °C or above
• is aged 3 months or older and has a temperature of 39 °C or above
• your child has a distinctive barking cough
• your child makes a harsh sound when they breathe in

Croup can usually be diagnosed by a GP and treated at home.

Read more about the symptoms of croup and diagnosing croup

Why does croup happen?

Commonly, croup is caused by a virus. Several viruses can cause croup but in most cases it is the parainfluenza virus.

Read more about the causes of croup

Who is affected by croup?

Croup usually affects young children aged between six months and three years, with most cases occurring in one-year-olds. 

However, croup can sometimes develop in babies as young as three months, and older children up to 15 years of age. Adults can also get croup but this is rare.

The condition is more common during the late autumn and early winter months. 

It tends to affect more boys than girls.

A child may experience croup more than once during childhood.

Treating croup

Most cases of croup are mild and can be treated at home. Sitting your child upright and comforting them if they are distressed is important, because crying may make symptoms worse. Your child should also drink plenty of fluids to prevent dehydration.

A single dose of an oral corticosteroid medication called dexamethasone or prednisolone will usually also be prescribed to help reduce the swelling in the throat.

If your child has breathing problems they may need hospital treatment, such as adrenaline and oxygen through a mask.

Read more about treating croup

Complications

Most cases of croup clear up within 48 hours. However, in some cases symptoms can last for up to two weeks.

It is extremely rare for a child to die from croup.

There are a number of conditions that can follow croup, such as pneumonia and middle ear infection.

Read more about the complications of croup.

Preventing croup

Croup is spread in a similar way to the common cold, so it is difficult to prevent.

Good hygiene is the main defence against croup, such as regularly washing hands and cleaning surfaces.

A number of your child’s routine vaccinations also protect against some of the infections that can cause croup. These include:

• MMR – protection from measles, mumps and rubella
• DTaP/IPV/Hib – protection from diphtheria, tetanus, whooping cough, polio and Haemophilus influenzae type b

Symptoms of croup

A child can get croup at any time of the year, although it’s more likely to occur during late autumn or early winter.

This may be because there are more viruses, such as colds and flu, around at this time of year.

Typical symptoms of croup include: 

• a bark-like cough
• a hoarse or croaky voice
• difficulty breathing
• a harsh grating sound when breathing in, called stridor

Stridor is often most noticeable when the child cries or coughs. But in more severe cases of croup it can also occur when the child is resting or sleeping.

Symptoms tend to be worse at night.

Some children have cold-like symptoms for a few days before developing croup symptoms.

These cold-like symptoms can include:

• sore throat
• runny nose
• cough 
• high temperature (fever)

Although croup symptoms usually only last for a few days, they can occasionally last up to two weeks.  

When to seek medical advice

Croup can usually be diagnosed by a GP and mild cases can be treated at home.

Immediate action required:

Take your child to A&E or phone 999 if your child:

• has severe breathing difficulties
• has an increased breathing rate (they’re too breathless to feed or talk) or ‘silent chest’ (you’re unable to hear sounds of breathing)
• has a worsening cough or rasping sound
• shows distress and agitation
• has dark, blue-tinged or pale skin
• the skin around their ribs and chest appears to be pulled in and tight, making the bones of their chest and ribs more visible
• has abnormal drowsiness and sleepiness
• has an inability to drink fluids

You should take them to your nearest hospital’s accident and emergency department or dial 999 for an ambulance.

Some of these symptoms may indicate a potentially life-threatening underlying condition called epiglottitis (inflammation and swelling of the epiglottis).

The symptoms could also indicate tracheitis (inflammation of the windpipe), which also requires immediate medical attention.

Causes of croup

Croup usually develops as the result of a viral infection. The infection causes the larynx (voice box) to become swollen and the trachea (windpipe) to become blocked, and may affect the tubes in the lungs (bronchi). It is sometimes called laryngo-tracheo-bronchitis

Parainfluenza virus

The parainfluenza virus is the most common cause of croup. Four strains of the virus are responsible for most croup cases. These are:

• parainfluenza I
• parainfluenza II
• parainfluenza III
• parainfluenza IV

Parainfluenza I is responsible for most cases of croup.

The virus can be transmitted through close contact with infected people, as well as contaminated objects and surfaces. As with many airborne viruses, the parainfluenza virus is often spread by breathing in droplets from infected coughs or sneezes.

Other viruses

A number of other viruses can also cause croup. These include:

• influenza A and B (flu viruses)
• the measles virus, in children who have not been immunised against measles
• the rhinovirus (common cold virus)
• enteroviruses
• the respiratory syncytial virus (RSV), which can cause severe breathing problems and pneumonia in babies

Other causes

Less common causes of croup include:

• inhaling a small object such as a peanut or a pen cap (inhaled foreign body)
• epiglottitis – inflammation of the epiglottis, (the flap at the base of the tongue that keeps food from going into the windpipe)
• an allergic reaction to substances such as pollen or dust mites
• inhalation of irritants, such as chemicals
• acid leaking back out of the stomach and into the throat (acid reflux)

Diagnosing croup

A GP can diagnose croup by studying your child’s symptoms, particularly the sound of their cough. They may also check your child’s temperature for a fever and ask whether they have recently had a cold or viral infection.

In some cases, a pulse oximetry test may be carried out. This involves clipping a sensor onto your child’s earlobe or finger to find out their oxygen levels.

The test does not hurt and should not distress your child, and determines whether your child is absorbing enough oxygen into their blood.

Your GP will decide whether your child needs to be admitted to hospital or whether their croup is safe to treat at home.

You should not try to check your child’s throat yourself, because it could trigger a spasm (sudden narrowing) of the airway. This could cause the airway to swell even more, making breathing even more difficult.

Ruling out other conditions

Croup can usually be diagnosed by studying your child’s symptoms, but your GP may want to rule out other conditions that can cause similar symptoms.

Other possible causes for your child’s symptoms are:

• an abnormality of the airway, which has been present from birth
• an abscess in the tissues in the back of the throat
• inhaled material (something they have breathed in)
• swelling of the deeper layers of the skin (angio-oedema)
• epiglottitis
• congenital lesion
• an allergic reaction

In very rare cases, epiglottitis (inflammation of the epiglottis) or tracheitis (inflammation of the windpipe) can cause similar symptoms to croup. In these cases, however, your child will usually feel very unwell generally, rather than just having the specific symptoms of croup.

Differentiating these causes from croup may require further tests.

Further investigation

If your child is admitted to hospital with severe croup, or if treatment is unsuccessful, further investigations may be needed to examine their neck and chest area for a possible obstruction.

An X-ray may be recommended if it is thought your child may have inhaled something and it is obstructing their airway. 

Treating croup

Treatment of croup depends on how severe the symptoms are. Most cases are mild and can be managed at home.

However, if your child has severe croup, they will need to be admitted to hospital urgently.

Treatment croup at home

If your GP thinks your child has mild croup, they will usually recommend managing it at home.

This will often involve using children’s paracetamol to ease any pain associated with the condition and may help lower your child’s temperature if they have a fever.

You should also ensure your child is well hydrated by encouraging them to drink plenty of fluids.

Comforting your child is also important because their symptoms may get worse if they are agitated or crying. If your child is distressed, sitting them upright on your lap will help to comfort and reassure them.

Your GP will usually prescribe a single dose of an oral corticosteroid medication called dexamethasone or prednisolone to help reduce swelling (inflammation) in your child’s throat. Side effects of these medications can include restlessness, vomiting, upset stomach and headache.

Steam treatment is not advised for the treatment of croup. There is no evidence that allowing your child to breathe in humid air, for example steam from a hot bath or shower in a closed room, will help.

You should seek urgent medical advice if you notice your child’s symptoms getting worse.

Painkillers for children

Painkillers, such as paracetamol and ibuprofen, are available in liquid form for children.  You can get liquid paracetamol and ibuprofen over the counter from pharmacies and some supermarkets.

Children under 16 years of age should not be given aspirin.

Speak to your pharmacist or GP if you are unsure about what type of painkiller is suitable for your child.

Do not use cough medicines or decongestants as these do not help ease the symptoms of croup. These treatments often have drowsy side effects, which can be dangerous when a child has breathing difficulties.

Hospital treatment

In severe cases of croup, treatment in hospital may be required.

Breathing problems, such as shortness of breath, are a major symptom of severe croup.

You should dial 999 immediately for an ambulance if your child is struggling to breathe.

If your child has severe croup, they may be given adrenaline through a nebuliser. This will help improve symptoms within 10 to 30 minutes and the effects should last for up to two hours. A nebuliser allows your child to breathe the medication as a mist.

If your child is very distressed and finding it difficult to breathe, they will be given oxygen through an oxygen mask.

As with milder cases of croup, oral dexamethasone or prednisolone will usually be given to help reduce any swelling in your child’s airways.

In rare cases croup may require hospitalisation, where a child may need intubation. During intubation, a tube is inserted either through a nostril or the mouth and passed down into the windpipe. This will help your child breathe more easily.

Intubation is usually performed under general anaesthetic. This means your child will be completely unconscious throughout the procedure so they do not experience pain or distress. 

Complications of croup

Complications that develop as a result of croup are rare.

Airway obstruction

If an obstructed airway is not treated promptly, it can lead to:

• severe breathing difficulty (respiratory distress)
• respiratory arrest (where breathing stops but the heart continues beating)

Always phone 999 for an ambulance if your child is struggling to breathe.

Your child may find it difficult to drink fluids as a result of an obstruction in their airway. However, it is important they have plenty of fluids to avoid dehydration.

If your child refuses fluids, try not to force them. This could distress your child and make the condition worse.

Secondary infection

A secondary infection can sometimes develop following the initial viral infection that caused croup. A secondary infection can potentially cause:

• pneumonia, a chest infection which causes swelling of the tissue in one or both lungs
• bacterial tracheitis, which is a serious and potentially life-threatening infection that can occur after a viral respiratory infection

Other complications

Although rare, other possible complications of croup can include middle ear infection and lymphadenitis, an infection of the glands of the immune system (lymph nodes).

Symptoms, What to Expect and When to See a Doctor

Croup is an illness that is usually caused by a virus. The tissues of the windpipe (trachea) and voice box (larynx) become swollen. The swelling narrows the trachea, which makes it harder for air to get into the lungs.

It often starts as a “cold.” Croup can cause a barky cough or hoarse voice and is usually worse at night.

Croup occurs most often during the fall and winter seasons, but it can occur year round. It usually affects children 3 months to 5 years of age. Croup is contagious (can be spread to others). A child can get croup more than once.

What You will Hear and See

At first, your child may have a stuffy or runny nose and may have a low fever. As the swelling gets worse, he or she will get a barky cough and his voice may sound hoarse.

When your child breathes in, you may hear a “crowing” or a high-pitched squeaking sound, called stridor. He may also breathe very fast or have retractions. Retractions are when the skin of the child’s neck or ribs pulls in when breathing in. Your child may become frightened or upset.

What to do

There is no medicine that will get rid of the virus, but you can do some things to help your child breathe easier until the infection goes away.

• Stay calm and try to keep your child calm. Crying and tension can trigger coughing.

• Offer fluids to keep him hydrated.

• Have him breathe in cool night air (dress appropriately) or humidified air.

• Avoid exposing your child to tobacco smoke or other irritants.

Call 911 or go to the emergency room if your child’s lips or face turns bluish, if he is working hard to breathe, cannot speak or drink, or is drooling.

Treating Croup with Medicines

• If your child is uncomfortable or has a fever, medicines such as ibuprofen (Advil®, Motrin®) or acetaminophen (Tylenol®) can be used. Follow the dosing directions for your child. See Helping Hand HH-I-105, Fever for more information.

• Avoid over-the-counter cough medicines. They do not help and may cause harm.

• If your child goes to the hospital or to urgent care, he may be given a steroid treatment and watched for a few hours to see if his breathing improves. Steroids help reduce the swelling and thus make breathing easier.

• Since croup is a viral illness, antibiotics would be ineffective and are unnecessary.

When to Call the Doctor

Call the doctor if your child:

• Gets worse

• Has stridor constantly when resting

• Is less than 1 year old with stridor or a croupy cough

• Seems to not be able to catch his breath

• Cannot speak because breathing is so difficult

• Drools and cannot swallow his saliva

• Has trouble swallowing liquids and refuses to drink

• Skin is blue around the mouth or fingernails during coughing

• Has nonstop coughing

• Has retractions after each breath and his chest hurts

• Is very tired and difficult to wake

• Croup cough lasts more than 10 days

If you have any questions, please call your health provider.

Croup (PDF)

HH-I-19 4/78, Revised 3/17 Copyright 1978 Nationwide Children’s Hospital

False croup in children | Children’s doctor

None of the children is immune from such a serious complication as false croup.

Syndrome with stenosis (narrowing) of the larynx can occur suddenly against the background of any viral disease, severe colds, and even allergies.

Croup can develop as a complication during severe inflammation of the larynx. Its occurrence is always closely related to the strong swelling of the tissues, their increase in size, and, as a result, the narrowing of the larynx in the narrowest place – in the region of the vocal cords.

True croup is swelling and shortness of breath only in the area of ​​the ligaments, it occurs with diphtheria. False croup has a greater prevalence and a greater number of causes. It is less dangerous than the true one, but with untimely treatment or improperly provided assistance, it can also be fatal.

In children, the respiratory organs have certain age differences that contribute to the development of croup. Their respiratory tract is loose and narrow, the larynx is smaller than in adults, in size and proportion. As a result, severe edema that accompanies, for example, laryngitis or laryngotracheitis can literally “block” the child’s oxygen.

In the risk group for such a complication in acute respiratory viral infections, influenza and other common and typical diseases in childhood – babies from birth to 3 years. This age group accounts for more than half of all reported cases of false croup. After 6-7 years, children are much less at risk of suffering such a complication, and after 10 years, the risks are practically reduced to zero.

Causes

Most often, the cause of the development of false croup is the parainfluenza virus, other pathogens of acute respiratory viral infections, influenza. Bacteria by themselves rarely cause inflammation and swelling of the larynx and adjacent parts of the respiratory system. But they can join as a secondary infection.

Croup rarely develops on its own . In 99.9% of cases, false croup acts as a complication of rhinitis, pharyngitis, laryngitis, chickenpox, scarlet fever, and chronic tonsillitis in the acute stage. As concomitant factors, weakened immunity of the child can be considered, which, due to age and the underlying disease, cannot resist the spread of the inflammatory process, prematurity, rickets, and other systemic diseases that the baby may have.

False croup differs from most diseases of the respiratory system in its ability to cause stenosis, in which the larynx closes critically, and sometimes completely, preventing the child from breathing.

Muscle spasms only increase stenosis. And the mucus, which is actively produced by the mucous membranes during the inflammatory process, “complements” this alarming picture and creates an additional obstacle to the passage of air into the lower respiratory tract.

False croup can develop in stages, or it can stop at one of the stages and begin to reverse development. Obstructive syndrome at the initial stage causes slight oxygen starvation, but the child’s body, which can compensate for everything, gives depth and saturation to breathing and compensates for the condition as best it can.

If the edema increases and the stenosis becomes more pronounced, the stage of decompensation will come. Oxygen deficiency will “hit” the cardiovascular system, kidneys and brain. This can cause severe consequences up to asphyxia or death from cardiovascular insufficiency.

False croup happens:

• First degree . This is a compensated stenosis, in which the child has shortness of breath during activity, movement, exercise. Inhalation is more difficult than exhalation.

• Second degree. This is croup with subcompensated disorders, in which shortness of breath appears in a child not only during exercise, but also at rest.

• Third degree. In this condition, oxygen starvation develops, shortness of breath is severe, lips may begin to turn blue, skin integuments may turn pale. The child has difficulty breathing.

• Fourth degree. This is the last and most severe complication, in which deep hypoxia develops, which can be fatal. All organs and systems of the child’s body suffer, and primarily the brain and nervous system. Some changes, even if the child can be saved, will be irreversible.

Symptoms

• False croup does not develop from the very beginning of the underlying disease. Usually, the first signs of laryngeal edema with stenosis begin 2-3 days after the onset of the disease. Parents can notice the warning signs by the most important diagnostic symptom – the appearance of a dry barking cough, which is often called “seal barking”.

• The cough is very rough, hysterical. As the edema develops, hoarseness may appear, but the voice does not completely disappear with false croup, as it happens with true diphtheria. During crying, coughing, the voice will intensify, and this is one of the main differences between a false croup and a true one.

Another characteristic sign is noisy breathing. It changes from the first minutes of croup development. It becomes dry, whistling, the degree of sound effects directly depends on the degree of narrowing of the larynx, on the stage of stenosis. In the initial compensated stage, shortness of breath will be insignificant, whistling will be episodic. At the second stage, shortness of breath will become dry and frequent, it will prevent the child from sleeping and concentrating, the first vascular disorders will begin – pallor of the skin will appear.

At the third decompensated stage, hoarseness, heart rhythm disturbances appear. The child ceases to be active, he is very drowsy, lethargic, because he experiences severe oxygen starvation. The baby may begin hallucinations, delusions, episodes of loss of consciousness. At the last stage of false croup, the most characteristic symptoms disappear – a barking cough and wheezing when inhaling. The child’s blood pressure drops, muscle cramps may appear, consciousness leaves him, plunging the baby into a hypoxic coma.

Most often, attacks of false croup occur at night. They are accompanied not only by severe shortness of breath and a suffocating cough, but also by panic fear, crying, anxiety of the child. The child needs urgent help.

Emergency

During an attack with a false croup, it is required to be able to provide emergency care correctly and quickly. It consists in immediately calling an ambulance. While the doctors are traveling, parents should try to calm the baby, because the inability to take a full breath frightens him, and during a fright, the muscles spasm and respiratory failure becomes even more severe.

The child should be put to bed and covered with a warm blanket, all windows and vents in the house should be opened, and if necessary, the child should be taken out onto the balcony so that he has constant access to fresh air. The influx of oxygen significantly facilitates the condition of the child.

The baby can be given one dose of the age-appropriate antihistamine in strict accordance with age-specific dosages. No other drugs needed , except for antipyretics, if the child has a high fever.

This is where the first aid ends. All other manipulations are carried out by a doctor. In severe cases of false croup, the child may need to be intubated. Therefore, it is impossible to refuse hospitalization in any case. Once removed, an attack of false croup may well return in a few hours, but it will be even more difficult and swift to recur.

Treatment

Mild false croup can be treated at home. Pathology of an average degree is treated in a hospital, severe croup requires the conditions of an intensive care unit.

Prophylaxis

Due to the high prevalence of viral infections in childhood, especially in autumn and winter, the risk of developing false croup is also assessed as significant. This is especially true for children who often get ARVI. That is why it is important that parents take care of the observance of measures that will help to avoid such a terrible and dangerous complication:

• There should be a humidifier in the child’s room. Relative humidity of 50-70% helps not only to protect the child from private illnesses, but also speeds up the recovery of babies as much as possible if they do get sick with a respiratory infection.

• It is advisable to have an inhaler in the house. He will help, if necessary, to carry out all the necessary procedures at home.

• During the illness of ARVI , the child should drink more, breathe enough humid air. Proper treatment is important to prevent complications. Do not give medications without the permission and prescription of a doctor, especially antibiotics. No need to give honey, red berries and put mustard plasters, so as not to aggravate the swelling.

• Hardening , outdoor activities and proper nutrition help to strengthen the immune system and reduce the risk of complications.

False croup: causes, symptoms, treatment

False croup

In medicine, croup is an acute inflammatory disease of the upper and lower respiratory tract, which is complicated by narrowing of the larynx. It is in this part of the respiratory system that the voice apparatus is located. Children are most often affected by croup (1). Why does this happen, what types of croup are isolated and how to treat the disease?

Croup and its causes

The term “croup” comes from the English verb to croup – to croak. Indeed, the main symptom of the disease is a barking, croaking cough, which develops against the background of an inflammatory process in the larynx. It can be caused by various reasons, among which may be:

• Diphtheria is an infectious disease that develops when infected with diphtheria corynebacteria. They produce a special toxin that contributes to the formation of a thickened plaque in the throat. This leads to narrowing and obstruction of the airways, difficulty swallowing, and damage to the vocal cords. Croup in diphtheria is called true (1).
• Viral respiratory diseases, or SARS (colds and flu). Croup, which develops against the background of a cold, is called false, or pseudo-croup. In medical terminology, the name acute stenosing subglottic laryngotracheitis or acute laryngitis is often used. It usually occurs with influenza, parainfluenza, respiratory syncytial, adenovirus infection (1).
• Bacterial infections – extremely rarely, false croup appears against the background of a primary bacterial infection. Pathogens can become Staphylococcus aureus, Haemophilus influenzae, Mycoplasma (1).

In adults, the disease is rare, more often children get sick, due to age-related anatomical features of the structure of the larynx. Its diameter is several times smaller than the diameter of the adult larynx. Smaller sizes are also the width of the glottis in babies, especially in infants. It is they who constitute the high-risk group for the development of the disease (4).

The disease most often occurs between the ages of 3 months and 3, rarely before 5 years. In boys, the disease occurs several times more often than in girls. The peak incidence occurs during the influenza and SARS season: autumn, winter and spring.

How can false croup occur in babies?

Viruses enter the nasopharynx with the inhaled air, and then spread to the larynx and trachea. Sometimes the lower respiratory tract – the bronchi – is affected. In this case, they speak of the development of laryngotracheobronchitis (2).

The disease can proceed in different ways: some children get sick quite easily, while others endure the disease severely and often end up in a hospital. The severity of false croup depends on many factors: the pathogen that caused the infection, the general condition of the child, his immune response, and others. There are four levels of severity.

Stage I is the easiest. Clinical symptoms of this form of the disease: barking cough, hoarseness, wheezing noisy breathing due to narrowing of the larynx or trachea. It appears only when the child cries or worries, that is, with tension (1.2).

II stage – moderate. In this course, wheezing appears already at rest, and when crying, it is greatly enhanced. The child also suffers from a barking cough. In such situations, the body no longer receives the required amount of oxygen due to impaired respiratory function, and a mild degree of respiratory failure occurs (1,2).

Stage III is much more severe: the child develops severe respiratory failure (1,2).

Stage IV false croup requires immediate, emergency medical care – in such cases, due to severe respiratory failure, the child develops severe shortness of breath, breathing is noisy, wheezing, the skin turns pale and becomes bluish. Due to an acute lack of oxygen, there is a growing clouding of consciousness (1,2).

Common manifestations

The first signs of the disease appear at the beginning of acute respiratory viral infections, on the 2nd-3rd day, less often on the 3rd-5th day. The general picture of a cold (runny nose, fever, sore throat, weakness, etc.) is joined by (3.5):

• hoarseness – appears due to impaired mobility of the vocal cords as a result of inflammation;
• “barking” cough – the result of irritation of the nerve endings due to swelling of the mucous membrane of the respiratory tract
• difficulty in inhaling, noisy, wheezing – appears at the moment of inhalation when air passes through the glottis narrowed due to inflammatory edema;
• increase in body temperature up to 38. 5-39°C, resulting from general intoxication of the body.

It is noteworthy that the attack of coughing and shortness of breath occurs more often at night. At this time of day, the vagus nerve is activated, which in turn stimulates the production of mucus, increases the contractile activity of the muscles of the respiratory tract. Due to the fact that the child lies, the drainage function of the lungs worsens. The decrease in respiratory function is also facilitated by the presence of the baby in an insufficiently ventilated room at night (4).

Against the background of fever, intoxication occurs, which is manifested by fatigue, weakness; at the same time the child becomes agitated and restless (3). Usually false croup in children is limited to I or II severity. Sometimes improvement occurs spontaneously, within 1-2 days after the onset of symptoms of laryngitis. But this is not always the case, especially in young children who are prone to developing bronchospasm (3).

When signs of false croup appear, it is important to see a doctor in order to diagnose and treat in time.

Inhalation therapy

The main goal of treatment is to restore airway patency, normalize respiratory and gas transport functions. Children, regardless of the severity of the condition, are shown to stay in conditions of high humidity – the rooms should be regularly ventilated, if necessary, use humidifiers (5.7).

Inhalation therapy plays an important role in the successful treatment of the disease. When inhaled, it is possible to quickly deliver medicinal substances directly to the area of ​​\u200b\u200binflammation – the upper and lower respiratory tract. One of the best methods of inhalation drug delivery is the use of nebulizers. They have a number of advantages:

• ensure reliable delivery of drugs to the respiratory tract, regardless of the baby’s inhalation activity;
• nebulizers are very easy to use, the inhalation technique is simple;
• when using nebulizers, it is possible to deliver a high dose of the drug, including to the most remote parts of the respiratory tract;

It is important that nebulizer therapy can be performed on children of any age, including very young ones.