CROUP

General Information

DEFINITION--Infection, inflammation and swelling of the larynx (vocal cords) and surrounding tissue. This causes labored breathing and a characteristic "barking" noise with each inhalation or cough.

BODY PARTS INVOLVED--Larynx; throat; bronchial tubes; trachea (windpipe).

SEX OR AGE MOST AFFECTED--Children under age 6.

SIGNS & SYMPTOMS

• Hoarseness.
• Barking cough and difficult breathing, especially at night.
• Chest or throat discomfort or pain.
• Fever.

CAUSES--Contagious viral infection (influenza virus type A, other parainfluenza and influenza viruses; respiratory syncytial virus; other viruses such as adenovirus, rhinovirus, enterovirus, Coxsackievirus, ECHO virus, measles virus).

RISK INCREASES WITH

• Past history of croup.
• Frequent upper respiratory infections.

HOW TO PREVENT--No specific preventive measures.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor (sometimes). There is no specific diagnostic test for croup.
• In rare instances, throat culture, neck x-ray or CT scan, and laryngoscopy (See Glossary for both).

APPROPRIATE HEALTH CARE

• Home care after diagnosis.
• Doctor's treatment.
• A child who has difficulty breathing may need to be hospitalized and may be given oxygen. Recovery usually takes 2 days.

POSSIBLE COMPLICATIONS--Complications are unlikely, but may occur depending on severity of the symptoms.

PROBABLE OUTCOME--Croup can be frightening, because attacks usually happen at night and the child has trouble breathing. In most cases, croup is not serious, and symptoms can be relieved. If attacks happen during the day and are accompanied by fever, the illness is more serious.

How To Treat

GENERAL MEASURES----Home care for a mild croup attack:

• Stay calm. Anxiety increases the child's breathing difficulty.
• Steam from a hot shower may help breathing. Hold child in your arms in the bathroom.
• Wrapping the child in a blanket and walking around outdoors occasionally helps.
• Keep the child comfortable in a semiseated position. Use TV, radio or a story for distraction so the child can relax. Crying can aggravate symptoms.
• Use a cool-mist, ultrasonic humidifier or vaporizer by the child's bed for several nights after an attack even if the child appears well. Simple croup often recurs. Clean humidifier daily.

MEDICATION--Usually no medicines are necessary for this disorder. In severe cases, your doctor may administer drugs that decrease airway obstruction or antibiotics if a bacterial infection occurs.

ACTIVITY--Decrease the child's activity and encourage rest as long as croup attacks are occurring. Don't allow the child to play outside in cool night air--this may trigger attacks (although cool air can help relieve symptoms during an attack).

DIET--Croup usually depresses appetite. Offer frequent small amounts of fluid, such as water, ginger ale, tea, juice or cola--not milk. Coughing may cause vomiting, so don't give the child solids during an attack.

Call Your Doctor If

• Your child is having trouble breathing and cannot swallow saliva or water. This is an emergency!
• Breathing rate increases to 80 breaths a minute.
• Breathing is labored, and retraction (the drawing in of neck and chest with each inhalation) is pronounced.
• Nails or lips become dark or blue.
• Child starts drooling or has trouble swallowing.
• You are worried.
• Mild croup symptoms don't improve with 30 to 60 minutes of cool-mist treatment.