Croup or laryngitis

This is the most frequent cause of acute obstruction of the upper airways in infants and pre-school age children. It is usually a mild disease with quick and full recovery.

How is it caused?

Croup is caused by various viruses or laryngeal spasm. Viruses affect children of 6 months up to 3 years old, usually during early autumn and winter. The most common virus that causes laryngitis is the para-influenza virus, however, the same symptoms can be caused by the respiratory syncytial virus, influenza virus, adenoviruses, the measles virus, and others.

Non-viral spasm of the larynx can occur throughout the year in children up to 5 years old, and it is probably an allergic reaction.


How is it transmitted?

The child becomes infected through direct contact with an infected person, or from the infected secretions of a person with the virus, e.g. infected objects.


How does it differ from a common cold?

The common cold is also caused by viruses, but it relates only to the upper respiratory system (nose, pharynx). With croup, the infection begins from the upper respiratory system, but slowly spreads downwards, causing an edema (swelling) around the trachea and the larynx of the child. Smaller children tend to be more seriously affected by laryngitis, because their airways are small, and even the mildest swelling can significantly obstruct them.


How does it occur?

It starts with a runny nose and dry cough, with or without mild fever. Symptoms vary from child to child. It usually occurs during the night with laboured or even rapid breathing, chest contractions, a characteristic sound when the child inhales (wheezing), a hoarse voice, and irritating, spasmodic coughing (like a dog barking).

In severe cases, the child turns blue, and his level of consciousness is reduced.
The symptoms resemble those of other diseases, so clinical examination and diagnosis by a paediatrician is important.

The duration of the symptoms varies, but they usually last from three to seven days.


How is the diagnosis made?

The diagnosis usually requires just the medical history and a clinical examination by a paediatrician. In some cases, the doctor may ask for the following tests:

• Oximetry, meaning the measurement of oxygen in the child’s blood. This is done simply with a sensor that is fixed around the child’s finger. It is not an invasive method and it doesn’t hurt. It helps recognize significant respiratory distress.

• A simple chest and neck x-ray, in order to ascertain if there is an edema (swelling) in the larynx and the trachea or another cause of obstruction (ie foreign body).

• Blood tests, in ambiguous or difficult cases.


How is it treated?

Contact your paediatrician.

A mild crisis can be treated at home. Sometimes exposure to cold air outdoors helps. Good airing of the room helps too. Furthermore, you can increase humidity in the house with steam or with a humidifier.

Keep calm and soothe the child. Keeping the child calm and quiet helps him/her makes less respiratory effort.

Make sure that the child drinks enough liquids. In case of fever or pain give paracetamol.

Don’t give cough suppressants or antibiotics.

The acute disease usually passes in 2-3 days, while a mild cough may persist for a week.

In more serious cases the paediatrician may prescribe dexamethasone. This is administered orally, and it can be repeated the following night if needed. It helps reduce the edema in the larynx.

In more severe crises, take the child to the emergency room. There, apart from the above, adrenaline can be administered by inhalation, and/or corticosteroids by inhalation or in an injected form, and the child’s respiration will be monitored for a few hours.

In severe crises the child will be hospitalized (1 in 10 children). It is usually difficult to rule out serious croup, because there is significant variability in the symptoms, the child seeming to be better one moment and worse the next. If in doubt, see a doctor immediately. The child might need oxygen.

Very rarely, the child might need respiratory support in the intensive care unit.

When to ask for medical assistance

• An older child with these symptoms needs to be examined for other causes, because it is rarely croup

• If the child has high fever

• If the child cannot swallow and is dribbling saliva

• If breathing is very difficult, fast, and laborious

• If the child’s color is blue or pale

• If the child can’t communicate with you, or is inactive, and the level of consciousness deteriorates

• If you are worried for any other reason, or you can’t cope


Stelios Papaventsis MRCPCH DCH IBCLC 2011

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