Croup
Croup syndrome — a term uniting a group of infections of larynx (voice box) whose common feature is the obstruction of the central airways (stridor). Stridor is one of the key symptoms of laryngeal obstruction. This term refers to the harsh, often high-tone sound created by the rapid, turbulent flow of air through the narrowed large airways.
In this article:
Treatment
Croup leads to signs of upper airway obstruction, and must be differentiated from acute epiglottitis, bacterial tracheitis, or an inhaled foreign body. Croup affects about 3% of children a year, usually between the ages of 6 months and 3 years, and 75% of infections are caused by Parainfluenza virus.
Symptoms usually resolve within 48 hours with only supportive measures, such as moist air, voice rest and pain/fever control. Rarely severe infection can lead to pneumonia, and to respiratory failure and arrest.
Although humidification and oral decongestants are often used in children with mild to moderate croup, there is no scientific evidence to support their use in clinical practice. Nevertheless, many parents swear by steamed bathroom being a cure, and use that for all their kids.
There is consensus that antibiotics do not improve symptoms in croup of any severity, as croup is usually viral in origin. At the same time, one dose of oral corticosteroids was found extremely effective.
Rates of hospital admission vary significantly between communities but, on average, less than 5% of all children with croup are admitted to hospital. Of those admitted to hospital, only 1%–3% are intubated. Mortality is low; in one 10-year study, less than 0.5% of intubated children died. Uncommon complications of croup include pneumonia, pulmonary oedema, and bacterial tracheitis.
Outpatient referral to ENT is recommended for children with multiple croup episodes and for those who present outside the usual age group for typical croup.
Acute laryngitis (croup) treatment
Acute croup usually happens at night and is scarry as the child if fighting to breathe. Most of the time parents decide to immediately go the ER. While urgent care may be needed for a very young child and for the croup that does not stop with simple measured, it is important to know what you can do to avoid unnecessary hospital trip during winter season.
Lifestyle and home remedies
There are some very effective home tricks that help treat croup in children:
- Steam. Open hot water in the bathroom to steam it up. Hold the baby in your arms – sometimes it is all that is needed to stop stridor.
- Distraction – irritated vocal cords spasm even more with the child being anxious and screaming. Try to run a favorite cartoon, a game or just walk outside. A sudden touch of an ice cube may produce needed distraction for a surprised child to stop crying and for a stridor to disappear.
- Avoid a voice strain. Try to console a child as fast as you can, as crying will make croup worse
- Warm chicken broth will provide a needed hydration and a boost to an immune system for recovery
- It is best to spend few nights sleeping in your baby’s room (if usually you child has a separate bedroom) to observe for breathing and discomfort.
References
Acute management of croup in the emergency department. Ortiz-Alvarez O.Paediatr Child Health. 2017 Jun;22(3):166-173. doi: 10.1093/pch/pxx019. Epub 2017 May 24.PMID: 29532807 Free PMC article.
Glucocorticoids for croup in children. Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP.Cochrane Database Syst Rev. 2018 Aug 22;8(8):CD001955. doi: 10.1002/14651858.CD001955.pub4.PMID: 30133690 Free PMC article.
Prednisolone Versus Dexamethasone for Croup: a Randomized Controlled Trial. Parker CM, Cooper MN.Pediatrics. 2019 Sep;144(3):e20183772. doi: 10.1542/peds.2018-3772. Epub 2019 Aug 15.PMID: 31416827 Free article. Clinical Trial.
Heliox for croup in children. Moraa I, Sturman N, McGuire TM, van Driel ML.Cochrane Database Syst Rev. 2018 Oct 29;10(10):CD006822. doi: 10.1002/14651858.CD006822.pub5.PMID: 30371952 Free PMC article.Updated.