Croup (Acute laryngotracheobronchitis)
What is croup?
Croup is a condition in which inflammation of the respiratory tract causes narrowing of the airways. It is very common in young children. However, older children and adults do not suffer from croup because their airways are wider and stiffer, making them less vulnerable to the effect of swelling due to inflammation.
Croup is characterized by a barking cough, breathing difficulty that is most pronounced when breathing in, and by a harsh and high-pitched sound when breathing out, due to swelling in the area of the vocal cords.
It is primarily a disease affecting children between the ages of six months and three years, although it may occur earlier or a little later. Croup is usually mild, but in severe cases it can produce extreme swelling that blocks the airway. Croup then becomes life-threatening and requires emergency treatment.
What causes croup?
that branch off from the trachea). The swelling and discharge from the inflammation may cause obstruction in the region beneath the vocal cords.
Symptoms often come on rapidly, preceded by several days of a cold with a cough, runny nose and perhaps a mild fever.
A croup attack most frequently occurs at night, waking the child up. The hoarseness and barking cough can be frightening for parents and child.
The pattern of the condition fluctuates rapidly and unpredictably. The child may have extremely labored, harsh breathing and then be breathing normally within an hour. Symptoms may disappear in the morning, only to recur at night. Croup usually runs its course in three or four days.
How is croup diagnosed and treated?
Diagnosis is based on the characteristic barking cough, hoarseness, and stridor (noisy breathing). These problems are generally worse at night.
Humidification (increasing the amount of moisture in the air) will often bring prompt relief. Breathing in steam-moistened air is one of the quickest ways to ease the coughing and breathing difficulty.
You can do this by producing a mist with towels over a pan of hot water, or you can run a hot shower or hot taps in a closed bathroom.
Mild croup can usually be treated at home, but a child who has severe breathing difficulties needs to be hospitalized. Hospital treatment involves giving moist air, either in a special room or with a face mask or a tent. Oxygen may be needed.
If breathing is severely obstructed an endotracheal tube may have to be passed down the throat into the trachea.
If this is impossible, because of the obstruction, a tracheostomy will have to be performed. Here a tube is passed directly into the trachea via an incision made in the throat below the obstruction.
- Laboured breathing.
- Grunting noise during breathing (stridor).
- Barking cough.
- Rapid breathing.
- Sore throat.
- Blue lips or nails (cyanosis).
When should I see my doctor?
You should consult your doctor immediately if a child in your care is having difficulty breathing. If the symptoms are severe and unrelieved by steam, or the child starts to turn blue (cyanosis, due to lack of oxygen in the blood), call an ambulance or take the child to the nearest hospital accident and emergency department.
What can I do to relieve croup?
- If your child is susceptible to croup when he or she has a cold, use a humidifier to keep air moist, especially in the child's bedroom.
- Encourage the child to drink plenty of fluids when he or she has a cold, and also use a vapour rub to reduce congestion in the airways.
What will the doctor do?
The doctor will examine the child to make sure that the problem is not due to a foreign object which is causing the blockage. If epiglottitis (a bacterial infection with similar symptoms) is suspected the doctor will prescribe antibiotics.
The bacterial infection diphtheria also causes breathing difficulties in young children, although it is now very rare in the UK as babies are routinely immunized against the disease. However, if the child has not been immunized against diphtheria the doctor will need to ascertain whether this may be the cause of the breathing problem.
To do this the doctor will take a throat swab so that any bacteria present can be grown in a laboratory and identified.
What can I do myself?
The child should be reassured and treated with moist air. A humidifier in the bedroom is helpful, and the child should be encouraged to drink plenty of fluids and to rest. If coughing becomes severe, get the child to breathe steamy air, for example in a bathroom.
Is croup dangerous?
If the child cannot breath, he or she will need urgent medical attention.
However, although croup can be frightening it is rarely dangerous. Even severe cases that need intubation (the insertion of a breathing tube) usually rectify themselves completely within a few days.
Epiglottitis, a serious condition caused by a bacterium, may be confused with croup. It is caused by infection of the epiglottis (a tiny protuberance at the back of the throat that prevents food from going down the windpipe). When this happens, breathing is completely obstructed and the condition can be life-threatening.