Croup

Definition

Croup is a common ailment of early childhood involving inflammation of the larynx, trachea, bronchial tubes, and lungs. The condition is characterized by a harsh, barking cough, wheezing, and difficulty in breathing.

Description

Croup is most likely to be found in children between the ages of three months to six years. Most incidences occur during the cold weather seasons.

Spasmodic croup is usually mild and may be due to bacterial infection or allergies. For the most part, the child will not have a fever. Viral croup, also called laryngotracheobronchitis, is more severe and is often accompanied by fever. Both types follow a very similar course, which depends on the severity of the illness.

In many instances, a child may have had a cold or the flu just before the onset of croup symptoms. These symptoms tend to come on very suddenly. It is not uncommon for a child with croup to waken in the middle of the night coughing violently and gasping for breath. In fact, the croup symptoms will usually be worse at night and get better during the day.

Causes & symptoms

During the immune system response to an infection or an allergic reaction, the respiratory passages become swollen, and they are congested with mucus and fluid. They also become more and more irritated. There is a great deal of coughing, and the child may become hoarse. The airways are narrowed, and the breathing is difficult and noisy. This leads to the characteristic symptom of stridor, or noisy aspiration, as the child attempts to draw in air through narrowed passages. The constriction of these airways is usually accompanied by a high-pitched cough, often described as sounding like the bark of a seal.

Diagnosis

Diagnosis of croup is primarily based on a good history taken by the health care provider, including the physical symptoms of the illness, the presentation of the illness, and its progression. If a physical exam is performed, it will probably include listening with a stethoscope for the breathing sounds which are characteristic of croup. When the symptoms appear to be severe, or the history suggests it, x rays may be taken to rule out epiglottitis (infection of the epiglottis) or aspiration of a foreign body, which are emergency situations.

Treatment

Supportive measures

Most treatment can be done at home, using relaxing and supportive measures to relieve symptoms. Steam inhalation is quite helpful in this respect. A cool-mist humidifier is recommended, as a hot vaporizer is often hazardous, especially around young children.

One of the best ways to produce a lot of moist air in a short time, is to make use of the bathroom shower. The procedure is to close the bathroom door and turn on the cool water shower faucet full blast. Then the child can be a held while seated on a chair or the closed commode, breathing in steam as it fills the room. This can be done for up to 15 minutes, and often brings instant relief from congestion.

Cool air seems to relax and soothe the respiratory system. Therefore, taking a car ride with the window rolled will sometimes effect good results in reducing the coughing associated with croup.

There is a strong possibility of dehydration due to the illness. Increasing fluid intake as much as possible and insuring plenty of rest will enhance immune functioning, helping the body to help itself. In addition, smoking should be prohibited within the house.

Herbs

Respiratory herbs can be used to soothe swollen and irritated tissues, reduce inflammation, and gently loosen and expel mucus. The following herbs should be given three times per day diluted in water or other liquids until symptoms are gone:

• Grindelia spp., gum weed, 1-2 ml
• Sambucus nigra, elder flowers, 2-4 ml
• Glycyrrhiza glabra, licorice root, 1-3 ml
• Verbascum thapsus, mullein, 2-4ml
• Astragalus senticocosus, 2-4 ml (This herb is an immune system stimulant and should be given as a preventative for those who have chronic bouts of croup.)

Slippery elm bark can also be taken, as it is soothing to the throat.

Homeopathy

Aconite is the most favored remedy to use for croup. If it does not work, Spongia can be tried, especially if the breathing sounds as if wood were being sawed. Alternately, try Hepar sulphuris, indicated by a mucus-filled cough. Give a dosage of 12X or 30C every 30 minutes until the child is able to fall asleep.

Allopathic treatment

In most cases, croup can be easily and successfully treated at home. However, if the symptoms become severe, the child will need to be seen by a physician. Prompt medical attention is needed if:

• The child's fever goes up to 104°F (39.9°C).
• The child seems pale or bluish around the mouth or fingernails.
• The child refuses all liquids or can't swallow.
• The child is drooling a great deal.
• The child's breathing becomes increasingly rapid or difficult.

Severe cases may warrant the use of inhalants, such as epinephrine, to reduce swelling and give the child easier breathing. Inhalants have limited effectiveness over time, and care must be taken to avoid undesirable side effects. Oxygen may also be administered in more severe cases. Corticosteroids are given to decrease pain and swelling.

If a child is hospitalized for further observation or treatment, intravenous (IV) fluids may be given to reduce dehydration. In a few very severe cases, a tube has to be inserted through the nose or mouth (intubation) to keep the airway passage open for breathing. There is a slight risk of injury to the respiratory system during the introduction and the removal of the tube.

Expected results

Croup ordinarily lasts three to seven days. Most cases are mild and gradually improve with care. Some children have recurring bouts with croup, but they usually outgrow this by seven years of age.

It is important to monitor a child with croup throughout the night. An adult should probably consider sleeping or resting nearby. If the child is having a serious struggle with breathing, emergency services should be contacted immediately. This means either calling 911 or making a trip to the nearest emergency room. Hospital visits are necessary in about one to 15% of the reported cases of croup.

Prevention

Croup is generally the result of an infectious disease. Avoiding exposure to others with respiratory infections is the best way to avoid getting croup. Children should be taught to maintain good hygiene practices such as not eating food from the silverware or dishes of others and washing their hands. Care should be taken with colds and the flu so that there is no progression to symptoms of croup.

In general, an adequate intake of vitamins A and C, bioflavonoids, and zinc can help to prevent the respiratory infections and allergic reactions that lead to croup.

Key Terms

Aspiration

Accidental inhaling of an object such as food into the airway passages. This is dangerous, in that it may cause obstruction and difficulty breathing.

Corticosteroid

A hormonal drug that acts on the immune system to control inflammation and swelling.

Epiglottitis

A serious bacterial infection that can develop rapidly and lead to airway obstruction.

Epinephrine

A hormonal drug used chiefly to stimulate to the heart

Inflammation

Reaction by body tissues to infection or injury. Usually the area will be hot, red, painful, and swollen due to the immune response.

Intravenous fluids

In cases of immediate need for hydration, nourishment, or medicine, a needle with tubing is inserted directly into the vein.

Intubation

A procedure in which a flexible tube is carefully passed down the throat to keep the breathing passage open.

Stridor

A noisy wheezing sound during breathing that may indicate an airway obstruction.

Further Reading

For Your Information

Books

• Bunch, Bryan, ed. The Family Encyclopedia of Diseases: a Complete and Concise Guide to Illnesses and Symptoms. New York: Scientific Publishing, Inc., 1999.
• The Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life, Inc., 1997.

Other

• "Childhood Infections" The Nemours Foundation. http://kidshealth.org. (1999).
• "The Common Cold" Natural Medicine Online. http://www.nat-med.com. (2000).
• "Croup" Merck & Co., Inc. http://www.merck.com.
• "Croup and Your Young Child" American Academy of Pediatrics. http://www.aap.org. (2000).

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.