Croup, also known as laryngotracheobronchitis, is a type of respiratory infection that is usually caused by a virus. Croup is an infection of the upper part of the airways, causing a hoarse voice and a barking cough. It is very common in children between two and five years old. The child’s voice sounds hoarse, and he has difficulties breathing, including coughing. Some children have difficulty swallowing and can drool, become restless or develop a high fever. The condition may last from a few days to several weeks.
Croup symptoms include a seal-like barking cough, which sounds worse on inhalation, and shrills and/or hoarse. In addition to the barking cough, croup symptoms may include stridor (noise from vibration of airway mucous membranes), nasal flaring, nasal congestion, and subcostal retractions (belly button drawing into the chest), and substernal retractions (bony sternum dipping into the abdomen).
Croup is the clinical term for swelling in the voice box (larynx) and airway. In all cases, it is a viral infection that starts with a cold or allergies. The inflammation causes hoarseness, and a cough, and can be life-threatening for young children.
As a parent, it may be hard to know when a cold becomes something more. Croup — a swelling of the vocal cords due to the irritation from viruses or allergies — can make your child’s cough last much longer than usual. If your child seems extra cough and irritated, here are some signs that could mean croup:
Any time, an infection in the upper airways can lead to shortness of breath and recurring cough. The airways are lined with moist linings that keep the passages clear. Some symptoms and signs of croup include a barking or seal-like cough, hoarseness, wheezing, and difficulty breathing. Breathing might be noisy, such as snoring or gasping. A fever may also be present. There may be anxiety seen with labored breathing since it is tiring to breathe. Croup seldom causes vomiting or diarrhea.
When to see a doctor
It is important to know when to seek medical care for your child’s sore throat. If your child’s symptoms are severe, worsening, or lasting longer than three to five days — or if they are not responding to home treatment — contact your child’s doctor.
- If your child makes noisy, high-pitched breathing sounds both when inhaling and exhaling, seek immediate medical attention. It is important to distinguish between infantile wheezing that resolves with briefly held mouth-to-mouth resuscitation and wheezing that persists after a minute of mouth-to-mouth resuscitation.
- If you are concerned that your child may be sick, take several minutes to monitor these signs: An infant or young child who is breathing faster than usual or is having trouble breathing may be lacking oxygen. They may also become pale or blue around their nose or mouth. Or they may develop greyish skin around the nose, mouth, or fingernails (cyanosis). Cyanosis can signal that blood is not getting to the body’s cells properly, which often points to heart failure as well.
Croup is a viral infection that causes your child to have difficulty breathing. People who have croup often have a hoarse voice and high-pitched cough that sounds like a seal barking. Because it is caused by a virus, there is no cure for croup. However, symptoms can be managed with medication and supportive care at home.
Croup differs from asthma in that it affects children ages 1 to 3 years old. It is often caused by a viral infection, such as parainfluenza. The first sign of croup is usually a barking cough that sounds like a seal barking or like your child is trying to suck air through a pinhole—hence the name “stridor.” Air moves too fast through the swollen airway causing loud noises. The voice box may swell (larynx). In severe cases, this swelling can block enough air from reaching the lungs that it causes very rapid breathing and reduces blood flow to the brain, which can lead to seizures. This can be life-threatening.
When children between six months and three years of age have cold symptoms, they are at risk of developing croup. Risk factors include being under one year old, having a family history of croup, being exposed to cigarette smoke or exhaust fumes, or having frequent upper respiratory infections.
Croup can be a frightening experience for parents, but most cases are mild. A small percentage of children with croup may develop a complication of the airway that interferes with breathing, and rarely, a secondary bacterial infection of the trachea can occur. Most children who are seen in the ER for croup require only observation or treatment with medications such as loratadine or steroids. Only a small number of children with croup need hospitalization.
Croup is a common illness in children. It is a struggle to keep the child from crying out in pain but try to comfort him or her as much as possible. To prevent croup, take the same steps you use to prevent colds and flu. Frequent hand-washing is the most important one. Keep your child away from anyone who is sick and encourage your child to cough or sneeze into his or her elbow if possible.
Vaccination is a critical part of your child’s health care. Make sure they are up to date on their vaccinations. Diphtheria and Haemophilus influenza type b (Hib) vaccines offer protection from some of the rarest — but most dangerous — upper airway infections. There is not a vaccine yet that protects against parainfluenza viruses.
Croup is usually diagnosed by a doctor. He or she will observe your child’s breathing, listen to his/her chest with a stethoscope and examine his/her throat. Sometimes X-rays or other tests are used to rule out other illnesses.
Treatment for croup typically includes supportive care, inhalations, and oxygen. Still, croup can be scary. If you hear your child’s airways make a bubbling sound when he or she breaths, or if your child appears uncomfortable with breathing and has flaring nostrils (one sign of obstructed breathing), contact your doctor immediately.
When your child has a cold, comforting him or her can be important in preventing coughing and gagging. Comforting measures such as holding, singing lullabies, and reading stories provide a haven for your child — a place where he or she feels comfortable, secure, and happy. It is also important to reassure your child that this is a minor illness that will soon pass.
Medication is typically used as a last resort to treat persistent or worsening cold symptoms. Most often, children are given antihistamines or nasal decongestants to dry up runny noses, decongest nasal passages, and relieve sneezing. These drugs include:
- Dexamethasone is a type of steroid (glucocorticoid) that may be given to reduce inflammation in the airway. Benefits are typically felt within a few hours after taking dexamethasone. A single dose of dexamethasone is usually recommended because of its long-lasting effects.
- Epinephrine, also known as adrenaline, is an effective treatment for allergic reactions that have progressed to anaphylaxis. Your child may be given an inhaled form of the medication using a nebulizer in the emergency room. However, you should observe him or her in the hospital for several hours after administration to determine if a second dose is required.
If your child has a severe case of croup that does not seem to improve after home treatment or one where he or she stops eating or drinking much and has trouble breathing, talk to your doctor. Your child may need to spend time in a hospital to be monitored and receive additional treatments. The goal is to make sure the airways are open so that your child can breathe normally again.
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