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Croup

Overview

Croup is a disease of the upper respiratory tract that causes swelling around the vocal cords, windpipe, and bronchial tubes. It causes difficulty breathing and is characterized by a loud, barking cough. This occurs when a cough forces its way out of swollen vocal cords. Inhaling during this condition also sounds like a high-pitched whistle for the same reason. Croup usually affects children below the age of 5 years. It goes away on its own in less than 7 days, but severe or recurrent cases need to be addressed with proper medical attention. 

Causes

Croup usually occurs due to a viral infection. Several viruses that propagate in cold temperatures can cause croup. Majority of the cases result from an infection caused by parainfluenza viruses. Other viruses that can cause croup include adenovirus, respiratory syncytial virus (RSV), and measles. These viruses are transmitted from one another through air droplets released during coughing or sneezing. Most of these viruses can also survive on surfaces of objects like toys, shelves, etc., for a certain period. Touching contaminated surfaces and touching your nose or mouth afterward can spread this infection.

 

Some cases of croup may also occur from a bacterial infection that affects your upper respiratory tract. Rare causes of croup include allergies, inhalational irritants, and toxins. 

Risk Factors And Epidemiology

Children below the age of 5 years are at risk of croup. The particular age range affected by this condition is from 6 months to 3 years. This is because children have a smaller and less developed respiratory passage than adults. Since many respiratory viruses propagate in cold weather, there is a high risk of croup in young children during winter. Positive family history of this condition can be another risk factor. Traveling to regions with active cases of upper respiratory illnesses can be dangerous for a young child.

 

Although croup may also occur in adults, it is a rarity. Majority of the cases occur in young children. Nearly 3% of children below the age of 5 years are affected by this disease worldwide. Croup is predominant among young boys than girls. 

Signs And Symptoms

Younger children around the age of 3 years develop more severe symptoms. The initial symptoms resemble the common cold. The child develops a fever, coughing, and runny nose. As the vocal cords and surrounding structures swell, breathing becomes more labored. This is followed by the development of its characteristic barking cough. When the cough is forced out of a narrow passage, it resembles the bark of a seal. Inhalation of air also creates a whistling noise when it flows through a constricted airway. The child's voice can sound hoarse when talking, which may worsen during crying. Agitation and irritability are other common symptoms. If a child develops severe difficulty breathing or swallowing or has a bluish tinge on the face and neck region, immediate medical attention is required. 

Diagnosis

Croup is usually diagnosed on the basis of its presenting symptoms. Your doctor may require a brief family and medical history. Clinical examination is performed in which your doctor listens to the child’s breathing with a stethoscope. Breathing rate and sounds are also observed. A throat examination can indicate swelling of the vocal cords and surrounding structures. If the diagnosis is unclear, your doctor may order a chest x-ray to look for other possible causes. 

Differential Diagnosis

Croup should be differentiated from other diseases that may present with similar symptoms. These diseases include epiglottitis, bacterial tracheitis, subglottic stenosis, foreign body obstruction, retropharyngeal abscess, and angioneurotic edema.

Treatment

The treatment options for croup may vary depending on the severity of your child’s symptoms. Mild to moderate cases of croup can be treated at home. You can consult a doctor on the phone for this purpose. Rest and intake of fluids are suggested to recover from viral infection. You can use cool mist humidifiers at your home that may facilitate normal breathing and promote peaceful sleep. Try to comfort an agitated child by singing lullabies, rocking gently, or giving a toy. Consistent crying can make breathing more difficult. Emergency medical attention is necessary if your child has severe difficulty breathing or swallowing. Your doctor may prescribe medications to open the airway or use a tube to supply oxygen. Your child may need to stay at a hospital for a few days until symptoms have recovered.

Medication

 

Over-the-counter analgesics such as acetaminophen, ibuprofen, etc., can be used to provide relief for chest pain and inflammation. In severe cases, the doctor will prescribe corticosteroid or epinephrine to open the airway passage and allow normal airflow. Bacterial croup may require a prescription of suitable antibiotics. 

Prognosis

Many cases of croup recover on their own within a week. Hospital treatment will be necessary if breathing difficulty or cough persists for more than 5 to 7 days. Medications can help in recovering from croup in a few days. 

Prevention

Croup can be prevented in children by avoiding viruses that cause upper respiratory tract infections. Guide your child about proper hand hygiene and ensure they wash their hands often. Keep your child at a distance from other children or adults who have an active infection. Disinfect toys and other common surfaces. Keep your child’s vaccinations up to date. There are no vaccines for the parainfluenza virus yet, but it can be prevented by following hygiene and safety measures.