Croup (patient information)
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Croup |
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Croup On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
Croup is breathing difficulty accompanied by a "barking" cough. Croup, which is swelling around the vocal cords, is common in infants and children and can have a variety of causes.
What are the symptoms of Croup?
Croup features a cough that sounds like a seal barking. Most children have what appears to be a mild cold for several days before the barking cough becomes evident. As the cough gets more frequent, the child may have labored breathing or stridor (a harsh, crowing noise made during inspiration).
Croup is typically much worse at night. It often lasts 5 or 6 nights, but the first night or two are usually the most severe. Rarely, croup can last for weeks. Croup that lasts longer than a week or recurs frequently should be discussed with your doctor to determine the cause.
What causes Croup?
Viral croup is the most common. Other possible causes include bacteria, allergies, and inhaled irritants. Acid reflux from the stomach can trigger croup. Viral Croup is usually caused by human parainfluenza virus, but RSV, measles, adenovirus, and influenza can all cause croup as well.
Who is at highest risk?
People with the following characteristics are at the highest risk for croup:
- Infants and children between 6 months and 6 years old
- Males
- People living in densely populated regions
- People traveling to and from developing countries
- People without an influenza vaccine
When to seek urgent medical care?
Most croup can be safely managed at home with telephone support from your health care provider. Call 911 if:
- The croup is possibly being caused by an insect sting or inhaled object
- The child has bluish lips or skin color
- The child is drooling
- The child is having trouble swallowing
Depending on the severity of the symptoms, call 911 or your health care provider for any of the following:
- Stridor (noise when breathing in)
- Retractions (tugging-in between the ribs when breathing in)
- Struggling to breathe
- Agitation or extreme irritability
- Not responding to home treatment
Do NOT wait until morning to address the problem.
Diagnosis
Children with Croup are usually diagnosed based on the parent's description of the symptoms and a physical exam. Sometimes a doctor will even identify croup by listening to a child cough over the phone. Occasionally other studies, such as x-rays, are needed. A physical examination may show chest retractions with breathing. Listening to the chest through a stethoscope may reveal prolonged inspiration or expiration, wheezing, and decreased breath sounds. A neck x-ray may reveal a foreign object or narrowing of the trachea.
Treatment options
Most cases of croup can be safely managed at home, but call your health care provider for guidance, even in the middle of the night. Cool or moist air can bring relief. You might first try bringing the child into a steamy bathroom or outside into the cool night air. If you have a cool air vaporizer, set it up in the child's bedroom and use it for the next few nights. Acetaminophen can make the child more comfortable and lower a fever, lessening his or her breathing needs. Avoid cough medicines unless you discuss them with your doctor first.
You may want your child to be seen by a doctor. Steroid medicines can be very effective at promptly relieving the symptoms of croup. Medicated gaseous treatments, if necessary, are also powerful. Serious illness requires hospitalization. Increasing or persistent breathing difficulty, fatigue, bluish coloration of the skin, or dehydration indicates the need for immediate medical attention or hospitalization.
Medications are used to help reduce upper airway swelling. This may include gaseous racemic epinephrine, corticosteroids taken by mouth, such as dexamethasone and budesonide, and inhaled or injected forms of other corticosteroids. Oxygen and humidity may be provided in an oxygen tent placed over a crib. A bacterial infection requires antibiotic therapy.
Increasing obstruction of the airway requires intubation (placing a tube through the nose or mouth through the larynx into the main air passage to the lungs). Intravenous fluids are given for dehydration.
Where to find medical care for Croup?
Directions to Hospitals Treating Croup
What to expect (Outlook/Prognosis)?
Croup usually goes away in 3 to 7 days upon infection. Most symptoms will resolve by 1 to 2 days after manifestation. The outlook for croup is good with prompt treatment of symptoms. For milder cases, prognosis is good even if absence of treatment. For more severe cases, prompt treatment is necessary to prevent airway obstruction that can lead to life-threatening respiratory distress, (severe difficulty breathing), and respiratory failure.
Possible complications
- Atelectasis (collapse of part of the lung)
- Bacterial tracheitis
- Dehydration
- Epiglottitis
- Respiratory arrest
- Respiratory distress
Prevention
Wash your hands frequently and avoid close contact with those who have a respiratory infection. The diphtheria, Haemophilus influenzae (Hib), and measles vaccines protect children from some of the most dangerous forms of croup.
Sources
http://www.nlm.nih.gov/medlineplus/ency/article/000959.htm Template:WH Template:WS