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Croup

Viral croup; Laryngotracheobronchitis - acute; Spasmodic croup; Barking cough - croup

 

Croup is breathing difficulty and a "barking" cough. Croup is due to swelling around the vocal cords. It is common in infants and children.

Causes

 

Croup is most often caused by viruses such as parainfluenza RSV, measles, adenovirus, and influenza. It tends to appear in children between 3 months and 5 years old, but it can happen at any age. Some children are more likely to get croup and may get it several times. It is most common between October and March, but can occur at any time of the year.

More severe cases of croup may be caused by bacteria. This condition is called bacterial tracheitis.

Croup may also be caused by:

  • Allergies
  • Breathing in something that irritates your airway
  • Acid reflux

 

Symptoms

 

The main symptom of croup is a cough that sounds like a seal barking.

Most children will have mild cold symptoms for several days before the barking cough becomes evident. As the cough gets more frequent, the child may have trouble breathing or stridor (a harsh, crowing noise made when breathing in).

Croup is typically much worse at night. It often lasts 5 or 6 nights. The first night or two are most often the worst. Rarely, croup can last for weeks. Talk to your child's health care provider if croup lasts longer than a week or comes back often.

 

Exams and Tests

 

Children with croup are most often diagnosed based on the parent's description of the symptoms and a physical exam. Sometimes a provider will listen to a child cough over the phone to identify croup. In a few cases, x-rays or other tests may be needed.

A physical exam may show chest retractions with breathing. When listening to the child's chest through a stethoscope, the health care provider may hear:

  • Difficulty breathing in and out
  • Wheezing
  • Decreased breath sounds

An exam of the throat may reveal a red epiglottis. A neck x-ray may reveal a foreign object or narrowing of the trachea.

 

Treatment

 

Most cases of croup can be safely managed at home. However, you should call your provider for advice, even in the middle of the night.

Steps you can take at home include:

  • Expose your child to cool or moist air, such as in a steamy bathroom or outside in the cool night air. This may offer some breathing relief.
  • Set up a cool air vaporizer in the child's bedroom and use it for a few nights.
  • Make your child more comfortable by giving acetaminophen. This medicine also lowers a fever so the child will not have to breathe as hard.
  • Avoid cough medicines unless you discuss them with your provider first.

Your provider may prescribe medicines, such as:

  • Steroid medicines taken by mouth or through an inhaler
  • Antibiotic medicine (for some, but not most cases)

Your child may need to be treated in the emergency room or to stay in the hospital if they:

  • Have breathing problems that do not go away or get worse
  • Become too tired because of problems breathing
  • Have bluish skin color
  • Is not drinking enough fluids

Medicines and treatments used at the hospital may include:

  • Breathing medicines given with a nebulizer machine
  • Steroid medicines given through a vein (IV)
  • An oxygen tent placed over a crib
  • Fluids given through a vein for dehydration
  • Antibiotics given through a vein

Rarely, a breathing tube through the nose or mouth will be needed to help your child breathe.

 

Outlook (Prognosis)

 

Croup is most often mild, but it can still be dangerous. It most often goes away in 3 to 7 days.

The tissue that covers the trachea (windpipe) is called the epiglottis. If the epiglottis becomes infected, the entire windpipe can swell shut. This is a life-threatening condition.

If an airway blockage is not treated promptly, the child can have severe trouble breathing or breathing may stop completely.

 

When to Contact a Medical Professional

 

Most croup can be safely managed at home with telephone support from your provider. Call your provider if your child is not responding to home treatment or is acting more irritable.

Call 911 if:

  • Croup symptoms may have been caused by an insect sting or inhaled object.
  • Your child has bluish lips or skin color.
  • Your child is drooling.
  • Your child is having trouble swallowing.
  • There is stridor (a noise when breathing in).
  • There is a tugging-in of the muscles between the ribs when breathing in.
  • Your child is struggling to breathe.

 

Prevention

 

Wash your hands frequently and avoid close contact with people who have a respiratory infection.

Many cases of croup can be prevented with immunizations. The diphtheria, Haemophilus influenzae (Hib), and measles vaccines protect children from some of the most dangerous forms of croup.

 

 

References

Bower J, McBride JT. Croup in children (acute laryngotracheobronchitis). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 61.

Cukor J, Manno M. Pediatric respiratory emergencies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 168.

Roosevelt, GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 385.

 
  • Lungs - illustration

    The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

    Lungs

    illustration

  • Throat anatomy - illustration

    Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

    Throat anatomy

    illustration

  • Voice box - illustration

    The larynx, or voice box, is located in the neck and performs several important functions in the body. The larynx is involved in swallowing, breathing, and voice production. Sound is produced when the air which passes through the vocal cords causes them to vibrate and create sound waves in the pharynx, nose and mouth. The pitch of sound is determined by the amount of tension on the vocal folds.

    Voice box

    illustration

    • Lungs - illustration

      The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

      Lungs

      illustration

    • Throat anatomy - illustration

      Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

      Throat anatomy

      illustration

    • Voice box - illustration

      The larynx, or voice box, is located in the neck and performs several important functions in the body. The larynx is involved in swallowing, breathing, and voice production. Sound is produced when the air which passes through the vocal cords causes them to vibrate and create sound waves in the pharynx, nose and mouth. The pitch of sound is determined by the amount of tension on the vocal folds.

      Voice box

      illustration

    Tests for Croup

     

       

      Review Date: 2/15/2016

      Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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