Croup, also known as laryngotracheobronchitis, is a viral infection that affects the upper airway, including the larynx (voice box), trachea (windpipe), and bronchi. It causes swelling in the airway, leading to a distinctive barking cough, hoarse voice, and stridor (a high-pitched, noisy breathing sound). Croup is most common in young children, typically affecting those between the ages of 6 months and 3 years. The condition is usually mild and resolves on its own, but in some cases, the swelling can become severe enough to cause breathing difficulties, requiring medical attention.
Symptoms
- Barking cough: A harsh, brassy cough that resembles the sound of a barking seal.
- Stridor: A high-pitched, noisy breathing sound, especially when inhaling.
- Hoarse voice: The swelling in the vocal cords can lead to a hoarse voice.
- Fever: Low-grade fever is common, but high fever can occur in more severe cases.
- Runny nose and congestion: Croup often begins with cold-like symptoms, including a runny nose, sneezing, and mild coughing before progressing to the more characteristic croup symptoms.
- Difficulty breathing: In moderate to severe cases, children may have labored breathing, with chest retractions (pulling in of the chest muscles) and rapid breathing.
Causes
- Influenza (flu) virus
- Respiratory syncytial virus (RSV)
- Adenovirus
- Enterovirus
Diagnosis
- Listen to breathing: The characteristic barking cough and stridor are key clues in diagnosing croup. The doctor may also listen for signs of wheezing or other abnormal breathing sounds.
- Measure oxygen levels: In more severe cases, a pulse oximeter may be used to check the child’s oxygen levels and ensure they are getting enough oxygen.
- X-rays: In rare cases where the diagnosis is unclear or to rule out other conditions, the doctor may order an X-ray of the neck to look for narrowing of the airway (often referred to as the “steeple sign” in croup).
Treatment Options
- Home care:
- Humidified air: Breathing in moist air, such as from a cool-mist humidifier or steamy bathroom, can help reduce airway irritation and ease breathing.
- Stay calm: Keeping the child calm is important, as crying can make breathing more difficult. Holding the child in an upright position can also help with breathing.
- Fluids: Ensuring the child stays hydrated is important, as dehydration can worsen symptoms. Encourage your child to drink plenty of fluids.
- Medications:
- Steroids: In moderate to severe cases, corticosteroids such as dexamethasone or prednisolone may be prescribed to reduce airway inflammation and swelling. Steroids can provide rapid relief and are typically given as a single dose.
- Epinephrine: For severe cases with significant airway obstruction, nebulized epinephrine may be administered to quickly reduce swelling in the airway. This treatment is often used in emergency situations to provide temporary relief while monitoring the child’s condition.
- Pain relievers: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help reduce fever and discomfort.
- Hospitalization:
In rare, severe cases where a child is having difficulty breathing or their oxygen levels are low, hospitalization may be necessary. The child may be given oxygen, steroids, or nebulized epinephrine to improve breathing. Close monitoring is essential to ensure the airway remains open.
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