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Symptoms and Treatment of Croup

What is this condition?

Croup is a severe inflammation and obstruction of the upper airway, occurring as acute laryngotracheobronchitis (most common), laryngitis, and acute spasmodic laryngitis. Croup is a childhood disease affecting boys more often than girls, typically between ages 3 months and 3 years. It usually strikes during the winter. Up to 15% of children with croup have a strong family history of this condition. Recovery is usually complete.

What causes it?

Croup usually is caused by a viral infection. Parainfluenza viruses cause two-thirds of such infections; adenoviruses, respiratory syncytial virus, flu and measles viruses, and bacteria (pertussis and diphtheria) account for the rest.

What are its symptoms?

The onset of croup usually follows an upper respiratory tract infection. Symptoms include a harsh, high-pitched respiratory sound, hoarse or muffled vocal sounds, varying degrees of laryngeal obstruction and respiratory distress, and a characteristic sharp, barklike cough. These symptoms may last only a few hours or persist for a day or two. As it progresses, croup causes inflammatory swelling and, possibly, spasms that can block the upper airway and severely limit breathing.

Each form of croup has additional characteristics:

• In laryngotracheobronchitis, the symptoms seem to worsen at night. Inflammation and swelling cause increasingly difficult exhalation, which frightens the child. Other characteristic features include fever, rattling sounds while exhaling, and scattered crackles.

• Laryngitis, which is caused by vocal cord swelling, is usually mild and produces no respiratory distress except in infants. Early signs include a sore throat and cough.

• Acute spasmodic laryngitis affects children between ages 1 and 3, particularly those with allergies and a family history of croup. It typically begins with mild to moderate hoarseness and a runny nose, followed by the characteristic cough and noisy inhalation (which often awaken the child at night), labored breathing with retractions, a rapid pulse, and clammy skin. The child's understandable anxiety may lead to increasing shortness of breath. These severe symptoms diminish after several hours but reappear in a milder form on the next one or two nights.

How is it Diagnosed?

When bacterial infection is the cause, throat cultures may identify organisms and also rule out diphtheria. A neck X-ray may show areas of upper airway narrowing and swelling. In evaluating the child, the doctor will look for foreign body obstruction (a common cause of croupy cough in young children) as well as masses and cysts.

How is it Treated?

For most children with croup, home care with rest, cool humidification during sleep, and fever-reducing medicines such as Tylenol (or another drug containing acetaminophen) relieve symptoms. However, severe breathing problems require hospitalization. The child usually recuperates in a mist tent, which provides constant humidification to help breathing. If bacterial infection is the cause, antibiotics are necessary. Oxygen therapy may also be required.