• Croup

    (Laryngotracheobronchitis)

    Definition

    Croup is swelling in the voice box and wind pipe. The swelling can make it difficult to breathe. This can cause a barking cough. Croup occurs most often in children between age six months and three years. This is because young children have a smaller airway. Airways become wider as children grow. This decreases the chance of croup in older children and adults.
    Upper Respiratory System in a Child
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    Causes

    Croup is caused by viral infections such as:

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition. Risk factors for croup include:
    • Age: three years or younger
    • Attending day care
    • History of croup
    • Family history of croup
    • Frequent upper respiratory infections
    • Colder months: October through March

    Symptoms

    Croup often begins with symptoms similar to an upper respiratory infection. The symptoms can come on suddenly and often at night. The following is a list of common croup symptoms:
    • Cough spasms
    • Cough that sounds like a barking seal
    • Hoarseness
    • Fever
    • A harsh, high-pitched sound when your child breathes in, especially when crying or upset
    • Trouble breathing, especially breathing in
    • Poor appetite and fluid intake
    More serious symptoms of croup that may require immediate medical attention include:
    • Bluish color of nails, lips, or around the mouth—This is an absolute emergency. Call 911.
    • Decreased alertness—This is also a very serious symptom. Call 911.
    • Restlessness or agitation—This can be due to dangerous lack of oxygen.
    • Struggling for each breath
    • Harsh, high-pitched breath sounds even at rest
    • Trouble swallowing
    • Drooling
    • Inability to speak due to trouble breathing
    • Nausea and vomiting
    • Dizziness or lightheadedness
    • Rapid, irregular heartbeat; chest pain
    • Rash or hives
    • High fever

    Diagnosis

    Your doctor will ask about your child's symptoms and medical history. A physical exam will be done.
    Tests are not always needed. If croup is severe or not clear, your doctor may request:
    • Blood tests—to check for signs of infection
    • Neck x-rays—to look for changes associated with croup
    • Laryngoscopy—a thin tube inserted into your mouth to look at throat tissue. A sample of mucus from your wind pipe may be taken. It will be tested for infection.

    Treatment

    The goal is to keep your airway open until the infection clears. The infection causing croup will resolve on its own in 5-7 days. Severe symptoms usually resolve in 3-4 days.
    If your child is diagnosed with croup, follow your doctor's instructions. Treatment options include:

    Home Care

    Your child may have trouble sleeping because of breathing difficulties. Moist air may help your child breathe easier. The following methods may help:
    • Use a cool humidifier in the bedroom.
    • Use your bathroom as a steam room. Bring your child into your bathroom and close the door. Turn the shower on the hottest setting. Sit in the steamy bathroom with your child. Your child's breathing should improve within 15-20 minutes.
    • Cool night air may also help. Sit with your child near an open window or step outside.
    Make sure your child has plenty of fluids. Choose water and unsweetened juices.

    Medication

    The doctor may recommend medicine, such as:
    • Acetaminophen or ibuprofen—These ease discomfort. Follow instructions on bottle.
    • Steroids—These reduce swelling in the airways. They can keep a child from becoming sick enough to need hospitalization.
    • Racemic epinephrine—This is delivered through breathing treatments. It is temporary help until steroid medications start to work.
    • Antibiotics—These are not helpful against a virus causing croup. But, they may be needed if there is an accompanying problem like an ear infection or pneumonia.

    Hospital Care

    For serious croup, your child may need to be hospitalized. Hospital care may include:
    • Croup tent—a cool, moist air delivered inside a plastic tent
    • Medications or breathing treatments—to treat inflammation and respiratory distress
    • Breathing tube—inserted into the throat to help keep the airway open
    • IV fluids—given directly into a vein
    • Monitoring oxygen level and heart rhythms
    • Tracheotomy—a surgical procedure to open the airway in children with severe breathing problems

    Prevention

    Croup usually occurs due to an upper respiratory infection. Take steps to decrease your child's chance of catching colds and flu. Wash your hands often. Avoid contact with people that have cold or flu when possible.
    Yearly influenza immunization can prevent cases of croup due to influenza A. Influenza immunization is strongly recommended for all children between the ages of six months and five years.

    RESOURCES

    American Academy of Pediatrics http://www.aap.org

    KidsHealth http://www.kidshealth.org

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Croup. American Academy of Family Physicians. Family Doctor.org website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/croup.printerview.all.html. Updated February 2010. Accessed July 17, 2012.

    DynaMed Editors. Croup. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com. Updated March 10, 2011. Accessed July 17, 2012.

    Kleigman RM, Jensen HB, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007.

    What is croup and how is it treated? American Academy of Pediatrics. Healthy Children.org website. Available at: http://www.healthychildren.org/English/health-issues/conditions/chest-lungs/pages/Croup-Treatment.aspx. Updated January 2012. Accessed July 16, 2012.

    Revision Information

    • Reviewer: Michael Woods
    • Review Date: 09/2012
    • Update Date: 00/91/2012
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