Croup

Croup: Excerpt from Professional Guide to Diseases (Eighth Edition)

Croup is a severe inflammation and obstruction of the upper airway, occurring as acute laryngotracheobronchitis (most common), laryngitis, and acute spasmodic laryngitis; it must always be distinguished from epiglottiditis. It’s derived from an old German word for “voice box” and refers to swelling around the larynx or vocal cords. Recovery is usually complete.

Causes and incidence

Croup usually results from a viral infection. Parainfluenza viruses cause 75% of such infections; adenoviruses, respiratory syncytial virus (RSV), influenza, and measles viruses account for the rest.

Croup is a childhood disease affecting more boys than girls (typically between ages 3 months and 5 years) that usually occurs during the winter. Up to 15% of patients have a strong family history of croup.

Signs and symptoms

The onset of croup usually follows an upper respiratory tract infection. Clinical features include inspiratory stridor, hoarse or muffled vocal sounds, varying degrees of laryngeal obstruction and respiratory distress, and a characteristic sharp, barking, seal-like cough. These symptoms may last only a few hours or persist for a day or two. As it progresses, croup causes inflammatory edema and, possibly, spasm, which can obstruct the upper airway and severely compromise ventilation. (See How croup affects the upper airway.)

Each form of croup has additional characteristics:

In laryngotracheobronchitis, the symptoms seem to worsen at night. Inflammation causes edema of the bronchi and bronchioles as well as increasingly difficult expiration that frightens the child. Other characteristic features include fever, diffusely decreased breath sounds, expiratory rhonchi, and scattered crackles.

Laryngitis, which results from vocal cord edema, is usually mild and produces no respiratory distress except in infants. Early signs include a sore throat and cough, which, rarely, may progress to marked hoarseness, suprasternal and intercostal retractions, inspiratory stridor, dyspnea, diminished breath sounds, restlessness and, in later stages, severe dyspnea and exhaustion.

Acute spasmodic laryngitis affects a child between ages 1 and 3, particularly one with allergies and a family history of croup. It typically begins with mild to moderate hoarseness and nasal discharge, followed by the characteristic cough and noisy inspiration (that usually awaken the child at night), labored breathing with retractions, rapid pulse, and clammy skin. The child understandably becomes anxious, which may lead to increasing dyspnea and transient cyanosis. These severe symptoms diminish after several hours but reappear in a milder form on the next one or two nights.

Diagnosis

The clinical picture is very characteristic, so the diagnosis should be suspected immediately. When bacterial infection is the cause, throat cultures may identify the organisms and their sensitivity to antibiotics and rule out diphtheria. On a posterior-anterior X-ray of the chest, narrowing of the upper airway (“steeple sign”) may be apparent. Laryngoscopy may reveal inflammation and obstruction in epiglottal and laryngeal areas. In evaluating the patient, assess for foreign body obstruction (a common cause of crouplike cough in a young child) as well as masses and cysts.

Treatment

For most children with croup, home care with rest, cool humidification during sleep, and antipyretics, such as acetaminophen, relieve symptoms. However, respiratory distress that’s severe or interferes with oral hydration requires hospitalization and parenteral fluid replacement to prevent dehydration. If bacterial infection is the cause, antibiotic therapy is necessary. Oxygen therapy may also be required. Increasing obstruction of the airway requires intubation and mechanical ventilation.

Inhaled racemic epinephrine and corticosteroids may be used to alleviate respiratory distress.

Special considerations

Monitor and support respiration, and control fever. Because croup is so frightening to the child and his family, you must also provide support and reassurance.

❑ Carefully monitor cough and breath sounds, hoarseness, severity of retractions, inspiratory stridor, cyanosis, respiratory rate and character (especially prolonged and labored respirations), restlessness, fever, and cardiac rate.

❑ Keep the child as quiet as possible. However, avoid sedation because it may depress respiration. If the patient is an infant, position him in an infant seat or prop him up with a pillow; place an older child in Fowler’s position. If an older child requires a cool mist tent to help him breathe, explain why it’s needed.

❑ Isolate patients suspected of having RSV and parainfluenza infections if possible. Wash your hands carefully before leaving the room, to avoid transmission to other children, particularly infants. Instruct parents and others involved in the care of these children to take similar precautions.

❑ Control fever with sponge baths and antipyretics. Keep a hypothermia blanket on hand for temperatures above 102° F (38.9° C). Watch for seizures in infants and young children with high fevers. Give I.V. antibiotics as ordered.

❑ Relieve sore throat with soothing, water-based ices, such as fruit sherbet and popsicles. Avoid thicker, milk-based fluids if the child is producing heavy mucus or has great difficulty in swallowing. Apply petroleum jelly or another ointment around the nose and lips to soothe irritation from nasal discharge and mouth breathing.

❑ Maintain a calm, quiet environment and offer reassurance. Explain all procedures and answer any questions.

When croup doesn’t require hospitalization:

❑ Teach the parents effective home care. Suggest the use of a cool humidifier (vaporizer). To relieve croupy spells, tell parents to carry the child into the bathroom, shut the door, and turn on the hot water. Breathing in warm, moist air quickly eases an acute spell of croup.

❑ Warn parents that ear infections and pneumonia are complications of croup, which may appear about 5 days after recovery. Stress the importance of immediately reporting earache, productive cough, high fever, or increased shortness of breath.

Pictures

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

More About Croup

• Back to disease: Croup: Introduction
• Next Book Extract About Croup: Whooping cough (Professional Guide to Diseases (Eighth Edition))
• More Book Extracts: All Online Books for Croup

More Medical Textbooks Online about Croup

Review other book chapters online related to Croup:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

 » Next page: Whooping cough (Professional Guide to Diseases (Eighth Edition))

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Whooping cough (Professional Guide to Diseases (Eighth Edition))
• Cough, barking (Professional Guide to Signs & Symptoms (Fifth Edition))
• Cough, productive (Professional Guide to Signs & Symptoms (Fifth Edition))
• Hemoptysis (Professional Guide to Signs & Symptoms (Fifth Edition))
• Respirations, stertorous (Professional Guide to Signs & Symptoms (Fifth Edition))

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City