Croup is a common childhood ailment. Typically, it arises from a viral infection of the larynx (voice box) and is associated with mild upper respiratory symptoms such as a runny nose and cough. The key symptom is a harsh barking cough. Croup usually is not serious, and most children recover within a few days. In a small percentage of cases, a child develops breathing difficulties and may need medical attention.
Demographics
Croup is most common in children between ages one and two years, with an incidence of 5–6 cases per 100 population. It accounts for about 15% of children’s doctor and emergency room visits in the United States. The number of cases peaks in late fall and early winter.
Description
At one time, the term croup was primarily associated with diphtheria, a life-threatening respiratory infection. Owing to widespread immunization, diphtheria has become rare in the United States and other parts of the developed world, and croup currently refers to a mild viral infection of the larynx. Croup is also known as laryngotracheitis, a medical term that describes the inflammation of the trachea (windpipe) and larynx.
Parainfluenza viruses are the typical root cause of the infection, but influenza (flu) and cold viruses may sometimes be responsible. All of these viruses are highly contagious and easily transmitted between individuals via sneezing and coughing. Children between the ages of three months and six years are usually affected, with the greatest incidence at one to two years of age. The characteristic harsh barking of a croupy cough can be very distressing, but it rarely indicates a serious problem. Most children with croup can be treated very effectively at home; however, 1–5% may require medical treatment.
Croup may sometimes be confused with more serious conditions, such as epiglottitis or bacterial tracheitis. These ailments arise from bacterial infection and must receive medical treatment.
Causes and symptoms
The larynx and trachea may become inflamed or swollen from an upper respiratory viral infection. The hallmark sign of croup is a harsh, barking cough. This cough may be preceded by one to three days of symptoms that resemble a slight cold. A croupy cough is often accompanied by a runny nose, hoarseness, and a low fever. When the child inhales, there may be a raspy or high-pitched noise called stridor, owing to the narrowed airway and accumulated mucus. In the presence of stridor, medical attention is required.
However, the airway rarely narrows so much that breathing is impeded. Symptoms usually go away completely within a few days. Medical treatment may be sought if the child’s symptoms do not respond to home treatment.
Emergency medical treatment is required immediately if the child has difficulty breathing, swallowing, or talking; develops a high fever (103F [39.4C] or more); seems unalert or confused; or has pale or blue-tinged skin.
Diagnosis
Croup is diagnosed based on the symptoms. If symptoms are particularly severe, or do not respond to treatment, an x ray of the throat area may be done to assess the possibility of epiglottitis or other blockage of the airway.
Treatment
Home remedies
Home treatment is the usual method of managing croup symptoms. It is important that the child is kept comfortable and calm to the best degree possible, because crying can make symptoms seem worse. Humid air can help a child with croup feel more comfortable. Recommended methods include sitting in a steamy bathroom with the hot water running or using a cool-water vaporizer or humidifier. However, although cool-mist therapy at home or in the hospital may add to the child’s comfort, it does little to treat the actual condition. The child should drink frequently in order to stay well hydrated. To treat any fever, the child may be given an appropriate dose of acetaminophen (like Tylenol). Children should not be given aspirin, as it may cause Reye’s syndrome, a life-threatening disease of the brain. Antihistamines and decongestants are ineffective in treating croup.
Medical treatment
If the child does not respond to home treatment, medical treatment at a doctor’s office or an emergency room could be necessary. Based on the severity of symptoms and the response to treatment, the child may need to be admitted to a hospital.
For immediate symptom relief, epinephrine (adrenaline) may be administered as an inhaled aerosol. Effects last for up to two hours, but there is a possibility that symptoms may return. For that reason, the child is kept under supervision for three or more hours. Steroids (corticosteroids) such as prednisone may be used to treat croup, particularly if the child has stridor when resting.
Of the 1–5% of children requiring medical treatment, approximately 1% need respiratory support. Such support involves intubation (inserting a tube into the trachea) and oxygen administration.
Alternative treatment
According to alternative practitioners botanical/herbal medicines can be helpful in healing the cough that is commonly associated with croup. Several herbs to consider for cough treatment include aniseed (Pimpinella anisum), sundew (Drosera rotundifolia), thyme (Thymus vulgaris), and wild cherry bark (Prunus serotina). Homeopathic medicine has been tried in treating cases of croup. When choosing the correct remedy (a common choice is aconite or monkshood, Aconitum napellus) is said by homeopathic practitioners to be useful in the success of this type of treatment.
Prognosis
Croup is a temporary condition and children typically recover completely within three to six days. Children can experience one or more episodes of croup during early childhood; however, croup is rarely a dangerous condition.
Prevention
Croup is caused by highly transmissible viruses and is often difficult to impossible to prevent.