A variety of infections involve the larynx (vocal cords) and trachea (the upper airway just below the larynx). When these structures become inflamed and irritated, they provoke a barking cough, noisy respirations, and in some cases labored breathing. Croup can be particularly difficult for a child under the age of three. The most common version of this problem, and the one for which the term croup is normally reserved, is viral croup (also called laryngotracheobronchitis, indicating that the larynx, trachea, and bronchi are involved). This is caused most often by the parainfluenzavirus and generally occurs in epidemics during the fall and early winter. If your child has croup, it is very likely that other children in your community have it as well. The illness usually lasts three to five days but may extend as long as a week.
Croup begins like a typical cold in a child between the ages of six months and three years. She then develops a seal-like barking cough that progresses to noisy congested breathing called stridor. Fever may occur, and acetaminophen may be given to reduce it and make the child more comfortable.
Croup frequently begins in the middle of the night. It can develop within a few hours after your child goes to bed. She may awaken frightened and distressed, with symptoms worsening when she is crying and agitated. As the illness progresses, the ongoing coughing and increased effort needed to breathe may cause her to use interest in food or fluids and become mildly dehydrated. In more severe cases, she will appear to gasp for air when at rest.
First, try to calm your child, because croup symptoms will worsen if she is upset. (This is one situation where it is appropriate to try to keep her happy, or at least comfortable, at all costs.) If she is breathing rapidly and noisily and appears to gasp for air even when at rest (that is, sitting quietly or lying down), take her immediately to the nearest emergency room. She may improve dramatically on the ride over (see below), but make sure she is evaluated anyway.
If she is not gasping when at rest, a time-honored home treatment for croup is steam, since moisture relieves congestion and opens the airways. The best way to create steam is to turn on a hot shower in your bathroom, close the door, and wait for the room to become foggy.
You can sit or stand with your child in the steam for 15 to 20 minutes. As an alternative, bundle her up and take her outside. Often the cool night air, especially when it is moist or foggy, will dramatically improve breathing.
If you don’t see much improvement after 15 to 20 minutes, call the doctor (or take the child to the nearest emergency room if she appears to be getting worse). The doctor will want to know how rapidly your child is breathing (count the number of breaths in a minute before you call), whether the spaces between her ribs are moving in and out with each breath, and her general appearance.
If she improves, put a humidifier in her room while she sleeps. Because this cycle may repeat itself, it would be wise for you to stay with your child to monitor her breathing throughout the night. If your child relaxes and sleeps through the night, she probably won’t need additional treatment except for steam and fluids. Over-the-counter cold and cough medicines are not particularly helpful for treating viral croup. Antibiotics are not effective unless a medical evaluation indicates that the symptoms are being caused by bacteria (see below). In some cases the doctor will recommend a short course of steroids, which decreases the severity of the symptoms in some children.
Severe croup might be treated in the emergency room (or in some offices) using medication called racemicepinephrine given as an inhaled aerosol. This usually helps the child breathe more easily for two or three hours. Some children with croup are sent home after one treatment and observation, while others who are more severely affected will be admitted to the hospital for further care, including frequent breathing treatments and oxygen as needed.
Other Illnesses with Croup Symptoms
Bacterial tracheitis is an uncommon complication cidviral croup in which bacteria invade the upper airway. Atypical scenario is that of a child who develops symptoms of viral croup but fails to improve or actually worsens despite standard treatment. This infection is sometimes seen in children who are older than those who usually have viral croup. The child with bacteriaitracheitis usually appears very ill, with high fever and increasingly severe shortness of breath. Prompt medical care is very important, because the upper airway can be-come so inflamed and swollen that the child is unable to obtain an adequate amount of air.
Epiglottitis is a rapidly progressive and very dangerous infection of the epiglottis, the soft tissue flap that covers and protects the airway whenever your child swallows. A child who has been well will rapidly develop high fever and an extremely sore throat. Within a few hours she will be unable to swallow and may lean for and actually drool rather than swallow. This condition is a medical emergency because the swollen epiglotris can suddenly block the airway, leading to suffocation. Fortunately, this disease has become extremely uncommon because most children are now routinely immunized against hemophilus influenza type B, the bacteria that causes epiglottitis
Whether croup symptoms involve the more common viral syndrome or the serious bacteria infections, all can significantly affect your child’s ability to breathe – sometimes with rapid changes in her condition. If you are at all uncomfortable with your child’s breathing pattern (or her general appearance) during one of these illness, don’t hesitate to take her to the nearest emergency facility, regardless of the time of day or night. If her breathing appears significantly compromised and you don’t feel you can transport her safely.