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  Croup

Croup is a respiratory disease sometimes referred to as croup syndrome which afflicts infants and young children, typically between 3 months and 5 years. The term croup does not refer to a single illness, but rather a group of conditions involving inflammation of the upper airways also known as laryngotracheobronchitis (LTB) that leads to a cough described as “barking” sounds particularly when a child is crying due to narrowing of the upper airways.

Croup Respiratory disease
Croup


Causes

Most cases of croup is often caused by parainfluenza virus types 1 and 3 but other viruses such as adenovirus, respiratory syncytial virus, influenza, measles and occasionally bacteria or allergic reactions can also be the culprit. Croup is most likely to occur during the winter months and early spring. Premature newborns are more prone to developed croup due to their smaller airways which can easily be narrowed with the inflammatory process. Another disease entity called spasmodic croup is a condition similar to the viral croup except that there are no accompanying symptoms of an infection such as high grade fever.

Signs and Symptoms

Croup is characterized by a harsh “barking” cough which is diagnostic. This is accompanied by stridor ( a high-pitched squeaking noise heard on inhalation), fast or difficult breathing and fever. The stridor is worsened with agitation or crying but can also be heard when the child is calm. Stridor is a sign of an upper airway obstruction due to partially blocked narrowed upper airways because of progressive inflammation and swelling particularly the windpipe (trachea) and the voice box (larynx). The symptoms peak 2 to 3 days after the onset of infection and viral croup usually lasts less than a week. In some cases of severe croup, the child may appear pale or bluish around the mouth (cyanosis) because of not getting enough oxygen.

Diagnosis

Croup is diagnosed by clinical symptoms. Doctors check for the characteristic barking cough, stridor on inspiration that may be accompanied by fever, cold symptoms such as runny rose or rhinorrhea or a recent viral illness. It is also important to exclude other causes of an upper airway obstruction such as foreign body lodged in the throat or inflammation of the epiglottis (epiglottitis), a flap of tissue that covers the opening of the windpipe. A neck x-ray may be taken to rule out any other reasons for the difficulty of breathing and in croup, a “steeple sign” is evident which signifies narrowing of the top of the airway.

Treatment

The treatment of croup depends on the severity of symptoms. One of the simplest ways to treat or help with croup is to inhale cool mist. Hospitals today use a "blowby" apparatus for this purpose, but taking the child outside in moist night air may achieve the same result. Alternatively, steam from hot water or a cool-mist humidifier will have a similar effect. Mild croup with no stridor, or stridor only on agitation, and just a cough may simply be observed, or a dose of inhaled, oral, or injected steroids such as dexamethasone may be given. Moderate to severe croup are typically hospitalized and require nebulized adrenaline or epinephrine in addition to steroids. Oxygen may be needed if hypoxia develops manifested by cyanosis. Endotracheal intubation is rarely needed (less than 1% of hospitalized patients) and reserved for respiratory arrest. Rest and increased fluids are recommended.

Complications

Majority of children recover from croup with no complications. Ear infections and pneumonia are complications that develop rarely in some children.

Prevention

The best ways to prevent the spread of viruses that cause croup is to practice frequent hand washing and avoiding contact with people who have respiratory infections.

When to Call Your Child's Doctor

Immediately call your child's doctor or seek medical attention if your child has any of the following symptoms:

• difficulty breathing, including rapid breathing, belly sinking in while breathing, or the skin
• between the ribs pulling in with each breath
• stridor
• pale or bluish color around the mouth
• drooling or difficulty swallowing
• greater inactivity than usual when ill
• high fever
• very sick appearance

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