What is croup?

croup

DEFINITION:

Laryngotracheobronchitis, or croup, is a viral infection of the upper respiratory tract causing difficulty breathing and cough.

SYMPTOMS:

  • Fever
  • Congestion
  • Hoarseness
  • Noisy inspiration
  • Barking cough
  • Difficulty breathing

CAUSES:

Viruses such as:

  • Parainfluenza virus
  • Respiratory syncytial virus (RSV)
  • Human metapneumo virus
  • Influenza virus

CONTAGION:

The viruses causing croup are contagious.  The symptoms of croup can occur in children up to 2 years of age. The illness is contagious through fomites and by respiratory droplets (coughing or sneezing). Fomites are surfaces contaminated with an infectious agent. People can touch the surface and then touch a child’s nose, mouth, or eyes and transmit the virus.

DIAGNOSIS:

A history of cold symptoms followed by difficulty breathing, (especially on inspiration) and a barking cough leads us to this diagnosis.  A physician can listen to the chest with a stethoscope and hear inspiratory wheezing (wheezing when a person breaths in). Some children may have retractions (sucking in of the abdomen and below the Adam’s apple of the neck), and nasal flaring. These are signs of respiratory distress. A blood test or a nasal wash can be done to determine the type of virus, although this is rarely necessary.

TREATMENT:

The treatment of croup, like most viruses, includes keeping the child as comfortable as possible as the virus runs its course. With croup, this will mostly include fluids, a cool mist humidifier, or turning the shower on hot and breathing in the steam.

In worst cases, children are admitted to the hospital. This is necessary if the respiratory distress is bad enough to warrant needing extra oxygen. This is usually done in a cool mist tent. The child is placed in a bed or a crib and a large plastic tent is placed over the bed or crib. A large oxygen mist unit pumps oxygen into the tent. Children are also given a medicine called racemic epinephrine by mist treatments. This medicine allows a temporary opening of the airways. This medicine is not usually given for home use because some children will worsen a few hours after a treatment. Steroids can be used to help decrease the inflammation around the airway to alleviate the respiratory distress. In worst cases, which are fortunately very rare, children are placed on a ventilator (breathing machine) to bypass the upper airway obstruction until the virus passes.

ONE DOCTOR’S OPINION:

I see most cases of croup in the winter. Typically, I will tell a parent to use a cool mist humidifier and fluids. One thing that seems to work is to have a child placed in their car seat and for a parent to drive around with the windows down. The cool air can break a croup coughing spasm and give some relief. I use steroids in many cases, even for home treatment, to try to keep children out of the hospital. Decadron, prednisone or prednisolone (Prelone, Pediapred, Orapred) seem to work the best. Rarely, what appears to be croup may be an inhaled foreign body, such as a small toy, or even a developing abscess around the tonsils. If patients are not improving with the usual care, I will order a chest x-ray to evaluate for these possibilities. Things that don’t work include antibiotics, cough suppressants, and cold medicines.

 

Written by Dr. Michael Bornstein, who has over 28 years of experience as a pediatrician. 

Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.