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Croup is a respiratory viral infection that frequently affects children. The infection impacts the upper respiratory tract, causing it to narrow and leading to increased difficulty in breathing. The tissues surrounding the voice box (larynx) and windpipe (trachea) swell. When a cough expels air through this constricted pathway, it can result in a seal barking-like noise. Inhaling often leads to the production of a high-pitched whistling sound known as stridor. Although the illness is typically not serious, severe and life-threatening symptoms can develop.
Croup is very infectious as the viruses responsible for the condition can easily be transmitted from person to person. Infants and children under the age of three are mostly affected by this condition. As the child become older, the infection becomes less common. This occurs because their windpipes widen, reducing the likelihood of swelling obstructing their breathing. Mild cases of croup may be treated at home.
Symptoms
Croup symptoms normally last less than a week. In most cases, symptoms get worse at night. Runny or stuffy nose is a common early symptom that often develops gradually. Mild to severe cases of croup may develop symptoms, such as:
- Fever
- Hoarseness of voice
- A loud barking cough that is exacerbated by weeping, coughing, anxiety, and distress
- Noisy or labored breathing
- Rash
- Eye redness
- Swollen lymph nodes
- Restlessness
- Retractions, or sucking in the skin on top of the child’s breastbone and around their ribcage
- Cyanosis
If the child experiences a fever persisting beyond three days, or mild croup symptoms that endure for more than a week, it is advisable to contact a healthcare provider. This is essential to ensure the child’s well-being and address any uncertainties or prolonged symptoms.
If the child experiences severe or worsening croup symptoms, it is crucial to promptly seek immediate medical assistance. The critical signs and symptoms to watch out for include difficulties in breathing, a bluish discoloration of the skin, severe coughing spells, trouble swallowing or excessive drooling, the inability to cry or speak due to breathing difficulties, the presence of a loud, high-pitched whistling sound during breathing, and the skin around the child’s ribs and the top of their breastbone retracting inward. Recognizing and acting upon these symptoms promptly is vital for the child’s health and safety.
Causes
Your child can contract a virus when inhaling infected respiratory droplets, expelled into the air through coughs or sneezes. Additionally, virus particles within these droplets can persist on toys and various surfaces. A child could get croup if they touch a surface that has a virus on it and then touch their eyes, nose, or mouth.
A viral infection is typically the primary underlying cause of croup. Parainfluenza, influenza, respiratory syncytial virus (RSV), measles, and adenovirus are some of the viruses that cause croup. The swelling of the child’s upper airways brought on by viral croup makes breathing challenging for them.
Risk factors
It is most common in children between the ages of 6 months and 3 years. Boys are also more likely to have it than girls. Generally, younger children are more likely to experience more croup symptoms due to their small airways. Older children rarely contract croup.
Diagnosis
The diagnosis of croup involves assessing the symptoms, performing a physical examination, and doing necessary tests.
- Physical examination: The signs and symptoms the child exhibits can typically tell the healthcare provider if they have croup. Barking cough and stridor are the most typical symptoms. To confirm, the healthcare provider will closely observe the child’s breathing, listen to their chest using a stethoscope, and check their throat.
- Other tests: A healthcare provider might request X-rays and laboratory tests if the child has a serious condition, although this is uncommon.
Treatment
Treatment for croup is based on how severe the child’s status is and whether it could get worse quickly. The treatment could also be affected by the child’s history of respiratory issues or if he or she was born prematurely.
Most cases of mild croup can be treated at home. However, it is important to monitor if the symptoms worsen, or whether the child needs hospital care.
- Comfort measures: It is important to monitor that the child gets enough fluids to be hydrated. They also need to be calmed and comforted since crying and distress can exacerbate airway edema, which makes breathing difficult.
Home care involves employing a cool mist humidifier to alleviate discomfort in the airways, which may be dry and irritated. Alternatively, one can spend time with the child in a bathroom filled with steam produced by hot water running in the shower.
Additional home remedies for croup include:
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- Allowing your child to breathe in cool air at night by opening a door or window.
- Managing your child’s fever with an over-the-counter (OTC) medication like acetaminophen or ibuprofen.
- Soothing your child’s cough with warm, clear liquids to help alleviate mucus buildup on their vocal cords.
- Eliminating smoking within your home, as smoke can exacerbate your child’s cough.
- Keeping your child’s head elevated using an extra pillow (avoid using pillows for infants younger than 12 months old).
- Medicines: These may be prescribed to help alleviate symptoms.
- Corticosteroid: Glucocorticoids, which are a form of steroids, are employed to reduce inflammation in the child’s larynx. The glucocorticoids most prescribed include dexamethasone and prednisolone. This medication starts alleviating the swelling within about six hours after the initial dose. Within a few hours, symptoms will typically start to get better. Typically, your child will require only one oral dose of the medication. If your child experiences vomiting or is unable to retain the medicine, their healthcare provider may administer dexamethasone intravenously (IV) or via an intramuscular (IM) injection.
- Epinephrine: Epinephrine is often administered as an inhaled mist or nebulizer. This normally begins to work within 10 minutes and lessens the swelling in the child’s airways. For severe symptoms, the child can get the treatment every 15 to 20 minutes. This medication lasts for no more than two hours. Before being sent home, the child will probably need to spend a few hours being monitored in the emergency room to see whether a second dose is necessary.
- Hospital admission: This may be necessary to closely watch the child’s condition and if additional treatments are necessary. This is often recommended for severe cases of croup.
