Croup (Laryngotracheobronchitis)

While upper respiratory illnesses affect the nasal passages, ear and throat, respiratory illnesses impact the lungs. In this chapter, we’ll discuss croup, pneumonia and bronchitis. You’ll learn the symptoms of each illnesses, when to seek medical attention and how to prevent them.

Croup (Laryngotracheobronchitis)

Croup is a viral infection that causes an inflammation of the larynx or voice box. It causes a loud, barking cough sounds similar to that of a seal.

It occurs most commonly in the late fall and winter and primarily affects children under the age of 5. Babies as young as three months can get the illness, but it’s most prevalent around 24 months. Croup can lead to breathing difficulties in children and results in the hospitalization of about 5 percent of children are seen in emergency rooms for the condition.

What Causes Croup?

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Croup is a contagious illness that can be spread among children. It is most often cause by the parainfluenza virus which is not related to influenza. Therefore, a flu shot won’t prevent croup. Anyone can get the parainfluenza virus, but is usually only causes croup in young children whose airways are smaller and more susceptible to inflammation.

What are the Symptoms of Croup?

Croup often starts out as a cold or other upper respiratory virus with nasal congestion, runny eyes, sneezing and sore throat. Over the course of the illness though, children will develop distinctive symptoms which can include:
• A “barky” cough that gets worse at night or when crying. The airways below the larynx swell and narrow during croup, causing the cough to take on a distinctive sound.
• Fever of less than 104°F,
• Difficulty swallowing,
• Irritability,
• Hoarse voice,
• Stridor.

While the barky cough can sound scary, stridor is the more concerning of croup symptoms. Stridor is a raspy, gaspy sound your baby may make when inhaling or exhaling. It indicates your baby is having difficulty breathing.
You should seek immediate medical attention for babies with stridor or any of these symptoms:
• Cyanosis (blue or graying skin around the nose, mouth and fingernails),
• Drooling or inability to swallow,
• Anxious agitation or listless fatigue,
• Inability to speak or make vocalizations,
• Fast breathing,
• Difficulty breathing or gasping for air,
• Signs of dehydration.

Don’t wait for a call back from a pediatrician for babies with difficulty breathing. Go directly to an emergency room.

Should My Child See a Doctor?

Most cases of croup are mild and symptoms will go away within three to five days.
While your baby may have a cough, if he or she is playing normally and sleeps well, a trip to the doctors’ office probably won’t be necessary.

However, a small percentage of children will experience difficulty breathing and need to see a doctor. If your pediatrician diagnoses croup, he or she may order a steroid to reduce airway inflammation. If your baby is having severe trouble breathing, the doctor may use epinephrine to provide immediate relief.

Can I Treat Croup at Home?

If your baby is breathing OK, there are steps to take to make your child feel better until symptoms subside.
• Keep baby calm. Crying and agitation can increase airway obstructions.
• On a cool night, take your baby outdoors for about 15 minutes where colder air will help restrict airways. You can also open the freezer and let your baby breathe in the cold air.
• Steam may also help reduce inflamed airways. Run a hot shower in the bathroom, close the door and stand in the bathroom with your baby for 15 minutes so the warm, moist air soothes his or her airways.
• Run a cool-mist humidifier while your baby is sleeping.
• Use acetaminophen or ibuprofen to treat fevers over 100.4°F.
• Keep baby upright in an infant seat or swing. Try putting pillows under the crib mattress so your baby’s head is elevated while sleeping.
• Make sure baby gets plenty of liquids to stay hydrated.
• Don’t use cough syrups as they can make croup worse.

How can I Prevent Croup?

Croup is spread by a virus so it’s important to keep your baby away from people who are sick. Also wash your hands and your baby’s hands frequently to reduce the chances of contracting a virus. Teach your child to cough and sneeze into his or her elbow to avoid getting other sick.

What is Spasmodic Croup?

Some babies develop a barking cough that’s caused by an allergy or by the reflux of acid from the stomach. If often comes on suddenly, sometimes in the middle of the night. There is usually not a fever or other cold-like symptoms.

Babies with this condition are usually given allergy or acid-reflux medications.

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