Cough, barking

Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. It's most prevalent in the fall and may recur in the same child.

A barking cough indicates edema of the larynx and surrounding tissue. Because children's airways are smaller in diameter than those of adults, edema can rapidly lead to airway occlusion—a life-threatening emergency.

Action stat!

Quickly evaluate a child's respiratory status, and then take his vital signs. Be particularly alert for tachycardia and signs of hypoxemia. Also, check for a decreased level of consciousness. Try to determine if the child has been playing with any small object that he may have aspirated.

Check for cyanosis in the lips and nail beds. Observe the patient for sternal or intercostal retractions or nasal flaring. Next, note the depth and rate of his respirations; they may become increasingly shallow as respiratory distress increases. Observe the child's body position. Is he sitting up, leaning forward, and struggling to breathe? Observe his activity level and facial expression. As respiratory distress increases from airway edema, the child will become restless and have a frightened, wide-eyed expression. As air hunger continues, the child will become lethargic and difficult to arouse.

If the child shows signs of severe respiratory distress, try to calm him, maintain airway patency, and provide oxygen. Endotracheal intubation or a tracheotomy may be necessary.

History and physical examination

Ask the child's parents when the barking cough began and what other signs and symptoms accompanied it. When did the child first appear to be ill? Has he had previous episodes of croup syndrome? Did his condition improve upon exposure to cold air?

Spasmodic croup and epiglottiditis typically occur in the middle of the night. The child with spasmodic croup has no fever, but the child with epiglottiditis has a sudden high fever. An upper respiratory tract infection typically is followed by laryngotracheobronchitis.

Medical causes

Aspiration of foreign body.Partial obstruction of the upper airway first produces sudden hoarseness, and then a barking cough and inspiratory stridor. Other effects of this life-threatening condition include gagging, tachycardia, dyspnea, decreased breath sounds, wheezing and, possibly, cyanosis.

Epiglottiditis.Epiglottiditis is a life-threatening disorder that has become less common since the use of influenza vaccines. It occurs nocturnally, heralded by a barking cough and a high fever. The child is hoarse, dysphagic, dyspneic, and restless and appears extremely ill and panicky. The cough may progress to severe respiratory distress with sternal and intercostal retractions, nasal flaring, cyanosis, and tachycardia. The child will struggle to get sufficient air as epiglottic edema increases. Epiglottiditis is a true medical emergency.

Laryngotracheobronchitis (acute).Also known as viral croup, laryngotracheobronchitisinitially produces a low to moderate fever, a runny nose, a poor appetite, and an infrequent cough. When the infection descends into the laryngotracheal area, a barking cough, hoarseness, and inspiratory stridor occur.

As respiratory distress progresses, substernal and intercostal retractions occur along with tachycardia and shallow, rapid respirations. Sleeping in a dry room worsens these signs. The patient becomes restless, irritable, pale, and cyanotic.

Spasmodic croup.Acute spasmodic croup usually occurs during sleep with the abrupt onset of a barking cough that awakens the child. Typically, he doesn't have a fever, but may be hoarse, restless, and dyspneic. As his respiratory distress worsens, the child may exhibit sternal and intercostal retractions, nasal flaring, tachycardia, cyanosis, and an anxious, frantic appearance. The signs usually subside within a few hours, but attacks tend to recur.

Nursing considerations

▪ Don't attempt to inspect the throat of a child with a barking cough unless intubation equipment is available. (See Managing the patient with epiglottiditis.)

▪ If the child isn't in severe respiratory distress, a lateral neck X-ray may be done to visualize epiglottal edema.

▪ A chest X-ray may be done to rule out lower respiratory tract infection.

▪ Depending on the child's age and degree of respiratory distress, oxygen may be administered.

▪ Rapid-acting epinephrine and a steroid may be administered.

▪ Observe the child frequently, and monitor pulse oximetry.

▪ Provide the child with periods of rest with minimal interruptions.

▪ Maintain a calm, quiet environment and offer reassurance.

▪ Encourage the parents to stay with the child to help alleviate stress.

Patient teaching

▪ Teach the parents how to evaluate and treat recurrent episodes of croup syndrome.

▪ Teach parents how to administer prescribed medications.

Pictures

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Larynx symptoms

Read excerpts from these other book chapters related to Larynx symptoms:

Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Larynx symptoms

• Back to symptom: Larynx symptoms: Introduction (review 25 causes)
• Next Book Extract About Larynx symptoms: Cough, nonproductive (Nursing: Interpreting Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Larynx symptoms

More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

 » Next page: Cough, nonproductive (Nursing: Interpreting Signs and Symptoms)

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:

• Cough, nonproductive (Nursing: Interpreting Signs and Symptoms)
• Cough, productive (Nursing: Interpreting Signs and Symptoms)
• COUGH (Differential Diagnosis in Primary Care)
• HOARSENESS (Differential Diagnosis in Primary Care)
• STRIDOR AND SNORING (Differential Diagnosis in Primary Care)

Tools & Services:

• Bookmark this page
• Take a survey relating to Larynx symptoms
• 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