Children and Croup

Croup (laryngotracheobronchitis) is a general term for an acute condition that causes a brassy cough (sounds similar to a barking seal), and possibly hoarseness. It is usually caused by a viral infection that causes inflammation and swelling of the area near the vocal cords, trachea (windpipe) and bronchial tubes (small airways) in young children. Bacterial tracheitis and acute epiglottitis can also cause a crouplike illness but these infections are dangerous and life-threatening. In some children, croup is a recurring problem. Croup is more serious in infants and small children because their smaller airways can become narrow or blocked by the inflammation. Children outgrow croup as their airway passages grow larger. After age 7, croup is uncommon.

Usually preceded by a cold or fever, viral croup is marked by a distinctive seal-like barking cough, hoarseness and difficult breathing. Symptoms are usually worse at night. The child may start with a mild brassy cough and also may make a whistling or vibrating sound (called stridor) when taking a breath. As obstruction of the child's airway increases, the stridor becomes continuous, the cough becomes worse and the child has to work harder to breathe. There may be a slight fever, but it rarely reaches 102 degrees.  A high fever (above 102) suggests a more serious problem (epiglottitis or bacterial tracheitis) and requires emergency treatment.

Croup without fever (spasmodic croup) comes on suddenly during the evening or at night. The child may have seemed perfectly healthy during the day or had a mild cold, but suddenly wakes up with a violent fit of croupy coughing and feels anxious or frightened. The child has no serious difficulty breathing. The cause can be a viral infection, but other causes are allergic reactions and gastroesophageal reflux disease. The symptoms usually decrease over a few hours, and the child appears well the next morning.

Don't mistake croup for epiglottitis

Epiglottitis is a serious condition that can lead to death. It usually occurs in children 2 to 7 years old. It is caused by a bacterial infection of the upper respiratory tract that sometimes seems like severe croup with a fever. The bacterium that was the most common cause was H. influenzae type B. Thanks to the Haemophilus influenza type B (Hib) vaccine, epiglottitis is now very rare. Other bacteria, however, can cause it. Symptoms of epiglottitis are a high fever (102 degrees or higher), sore throat, stridor and difficulty breathing. The child drools and gasps for air, cannot talk and does not respond to the simple measures that bring relief of croup. The condition can rapidly progress to complete obstruction of breathing and death. The child must receive immediate medical attention. Epiglottitis usually starts and progresses very quickly, which distinguishes it from croup. Often the child is apparently well at bedtime and awakens with trouble breathing, croup, fever and an inability to talk .

Don't mistake croup for bacterial tracheitis

This is an acute infection of the upper airway that, like epiglottitis, can be life-threatening. Several bacteria can cause tracheitis, including Staphylococcus aureus and H. influenzae. It usually affects children younger than 3. Symptoms of bacterial tracheitis include a brassy cough, high fever and difficulty breathing. Like epiglottitis, tracheitis requires immediate medical attention.

Self-Care Steps for Croup

Most children with croup can be cared for at home. Three key elements in treatment are providing moist air, keeping the child sitting up or propped up and encouraging the child to drink plenty of fluids.

• Cough medicines and antibiotics are not effective in treating croup.

• Add moisture to the air to make it easier to breathe. The simplest method to do this is to take the child into the bathroom, close the door and turn on the hot water faucet of the shower. Sit with the child upright on your lap on the bathroom floor for 15 to 20 minutes, inhaling steam. Other options are a brief walk outdoors or a cold-mist humidifier in the child's bedroom.

• Avoid exposure to smoke from cigarettes, fireplaces or wood-burning stoves.

• Give plenty of clear, warm fluids, such as water or diluted juice, to prevent dehydration and help loosen the cough.

• Use a non-aspirin pain reliever (acetaminophen) to reduce fever and discomfort. Do not give a child aspirin, because use of this medication in children and teenagers has been linked to a rare but serious condition known as Reye's syndrome.

• Elevate the head of your child's bed.

• A child with croup is often frightened and crying, so try to reassure your child with a hug or distract him or her with a book or favorite game.

• Call your doctor if your child has croup symptoms for more than three nights or is having difficulty breathing.