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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.

Upper Respiratory System in a Child

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Causes    TOP

Croup is caused by viral infections such as:

Risk Factors    TOP

Croup occurs most often in children between age 6 months and 3 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.

Factors that may increase the risk of croup include:

Symptoms    TOP

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 for emergency medical help right away .
  • Decreased alertness—This is also a serious symptom. Call for emergency medical help right away .
  • 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
  • Lightheadedness
  • Rapid, irregular heartbeat; chest pain
  • Rash or hives
  • High fever

Diagnosis    TOP

You will be asked 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    TOP

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.

Treatment options include:

Home Care

Sleeping may be difficult because of breathing difficulties. Moist air may help a child breathe easier. The following methods may help:

  • Use a cool humidifier in the bedroom.
  • Use the bathroom as a steam room. Bring the child into the bathroom and close the door. Turn the shower on the hottest setting. Sit in the steamy bathroom with the child. Breathing should improve within 15-20 minutes.
  • Cool night air may also help. Sit with the child near an open window or step outside.

Encourage drinking plenty of fluids. Choose water and unsweetened juices.

Medication

The doctor may recommend medications, 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    TOP

A child with serious croup may need to be hospitalized. Hospital care may include:

  • Croup tent—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
  • Monitoring oxygen level and heart rhythms
  • Tracheotomy —a surgical procedure to open the airway in children with severe breathing problems

Prevention    TOP

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 who 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 6 months and 5 years.

RESOURCES:

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org
Kids Health—Nemours Foundation
http://www.kidshealth.org

CANADIAN RESOURCES:

About Kids Health—The Hospital for Sick Children
http://www.aboutkidshealth.ca

References:

Croup. Family Doctor—American Academy of Family Physicians. website. Available at:
...(Click grey area to select URL)
Updated March 2017. Accessed September 21, 2017.
Croup. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114811/Croup. Updated May 3, 2017. Accessed September 21, 2017.
What is croup and how is it treated? Healthy Children—American Academy of Pediatrics website. Available at:
...(Click grey area to select URL)
Updated November 21, 2015. Accessed September 21, 2017.
Last reviewed September 2017 by EBSCO Medical Review Board Kari Kassir, MD
Last Updated: 9/17/2014

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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