What are the key symptoms of croup in children. How can croup be treated at home. When should parents seek immediate medical attention for a child with croup. What causes croup and which age groups are most commonly affected. How long does croup typically last and what are potential complications.

Understanding Croup: A Common Childhood Respiratory Condition

Croup is a respiratory condition that primarily affects young children, causing inflammation in the upper airway. This inflammation leads to the characteristic symptoms that parents and caregivers should be aware of. The condition typically impacts the windpipe (trachea), the airways to the lungs (bronchi), and the voice box (larynx).

The most distinctive feature of croup is a barking cough, often described as sounding like a seal’s bark. This is accompanied by a harsh, raspy sound known as stridor when the child breathes in. Children with croup may also experience hoarseness and difficulty breathing due to the narrowing of their airway.

Age Groups Most Affected by Croup

While croup can occur at various ages, certain groups are more susceptible:

• Most common in children aged 6 months to 3 years
• Peak incidence in 1-year-olds
• Can affect infants as young as 3 months
• May occur in older children up to 15 years of age
• Rare cases in adults

It’s worth noting that croup tends to affect more boys than girls, and it’s more prevalent during the late autumn and early winter months. Some children may experience recurrent episodes of croup throughout their childhood.

Recognizing the Symptoms of Croup

Identifying croup early can help parents and caregivers respond appropriately. The main symptoms to watch for include:

1. A distinctive barking cough
2. Stridor (harsh breathing sound) when inhaling
3. Hoarse voice
4. Difficulty breathing

These symptoms often worsen at night and can be exacerbated by crying or agitation. In some cases, children may also experience a fever, although this is not always present.

Is croup contagious?

Yes, croup is contagious. It spreads in a manner similar to the common cold, primarily through respiratory droplets. This makes prevention challenging, but good hygiene practices can help reduce the risk of transmission.

Causes and Risk Factors for Croup

Understanding the underlying causes of croup can help in its management and prevention. The condition is primarily viral in nature, with several potential culprits:

• Parainfluenza virus (most common cause)
• Respiratory syncytial virus (RSV)
• Influenza virus
• Measles virus (in unvaccinated children)

These viruses lead to inflammation and swelling of the upper airway, resulting in the characteristic symptoms of croup. In rare cases, croup may be caused by bacterial infections or allergic reactions.

Are some children more prone to croup?

While any child can develop croup, certain factors may increase the risk:

• History of upper airway abnormalities
• Premature birth
• Previous episodes of croup
• Family history of croup

Home Management of Croup: Tips for Parents

Most cases of croup are mild and can be effectively managed at home. Here are some strategies parents can employ:

1. Keep the child calm and comfortable, as agitation can worsen symptoms
2. Ensure the child remains hydrated by offering plenty of fluids
3. Use a cool-mist humidifier in the child’s room to help ease breathing
4. Sit with the child in a steamy bathroom for 10-15 minutes
5. Encourage rest to aid recovery

It’s important to note that while these measures can provide relief, they do not treat the underlying viral infection. The body’s immune system will naturally fight off the virus over time.

Can over-the-counter medications help with croup?

Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage fever and discomfort associated with croup. However, cough suppressants are not recommended as they may interfere with the body’s natural clearing mechanisms.

Medical Treatment Options for Croup

While many cases of croup can be managed at home, some may require medical intervention. The primary goals of treatment are to maintain airway patency, reduce inflammation, and provide supportive care.

• Corticosteroids: A single dose of dexamethasone or prednisolone is often prescribed to reduce airway inflammation
• Epinephrine (adrenaline): In more severe cases, nebulized epinephrine may be administered to quickly reduce airway swelling
• Oxygen therapy: For children with significant breathing difficulties

In rare, severe cases, hospitalization may be necessary to closely monitor the child’s breathing and provide more intensive treatment if needed.

How quickly do medications work for croup?

Corticosteroids typically begin to reduce inflammation within a few hours, with maximum effect occurring within 6-12 hours. Nebulized epinephrine can provide rapid relief, often within minutes, but its effects are short-lived, necessitating close monitoring.

When to Seek Immediate Medical Attention

While most cases of croup are mild, some situations require urgent medical care. Parents should seek immediate medical attention if their child:

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

Additionally, parents should contact their healthcare provider if their child is less than 3 months old with a temperature of 38°C or above, or 3 months or older with a temperature of 39°C or above.

How do doctors diagnose croup?

Doctors typically diagnose croup based on the characteristic symptoms and a physical examination. In some cases, they may order additional tests such as:

• Pulse oximetry to measure blood oxygen levels
• Chest X-ray to rule out other conditions
• Viral tests to identify the specific causative agent

Potential Complications and Long-Term Outlook

While croup is generally a self-limiting condition, it’s important to be aware of potential complications and the typical duration of symptoms.

Most cases of croup resolve within 48 hours, but symptoms can persist for up to two weeks in some instances. Complications, while rare, can include:

• Pneumonia
• Middle ear infection
• Dehydration
• Rarely, severe breathing difficulties requiring intensive care

It’s important to note that fatalities from croup are extremely rare in developed countries with access to modern medical care.

Can croup recur in the same child?

Yes, some children may experience recurrent episodes of croup. This is more likely in children with a family history of croup or those with certain anatomical features of the airway. However, as children grow and their airways become larger, they typically outgrow the tendency to develop croup.

Prevention Strategies: Minimizing the Risk of Croup

While it’s challenging to completely prevent croup due to its viral nature, certain measures can help reduce the risk:

1. Practice good hand hygiene: Regular handwashing can limit the spread of viruses
2. Avoid close contact with infected individuals
3. Promote a healthy lifestyle: Adequate sleep, nutrition, and exercise can boost the immune system
4. Keep vaccinations up to date: Some vaccines, like those for influenza and measles, can prevent viruses that may cause croup
5. Avoid exposure to irritants: Secondhand smoke and other airway irritants may increase susceptibility to croup

By implementing these strategies, parents and caregivers can help minimize the risk of croup and other respiratory infections in children.

Are there any long-term effects of recurrent croup?

In most cases, croup does not lead to long-term health issues. However, children with frequent episodes of croup should be evaluated by a pediatrician or ear, nose, and throat specialist to rule out any underlying airway abnormalities or other conditions that may predispose them to recurrent croup.

Croup in Special Populations: Considerations for High-Risk Groups

While croup can affect any child, certain groups may be at higher risk for more severe symptoms or complications. These include:

• Premature infants
• Children with chronic lung diseases
• Children with compromised immune systems
• Those with congenital heart defects

For these high-risk groups, close monitoring and early intervention are crucial. Parents of children in these categories should have a low threshold for seeking medical attention if croup symptoms develop.

How does croup management differ in high-risk children?

Management of croup in high-risk children may involve:

• Earlier and more aggressive use of corticosteroids
• Lower threshold for hospital admission
• More intensive monitoring of oxygen levels and respiratory status
• Consideration of additional supportive therapies

Healthcare providers may also develop individualized action plans for children with recurrent croup or those at high risk for complications.

Understanding croup, its symptoms, and appropriate management strategies can help parents navigate this common childhood condition with confidence. While croup can be distressing for both children and parents, it’s important to remember that with proper care and attention, most cases resolve without complications. By staying informed and knowing when to seek medical help, parents can ensure the best possible outcomes for their children.

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.