Croup

Croup: Description:1. Acute obstruction of upper airway in infants and children characterized by a barking cough with difficult and noisy respiration caused by parainfluenza viruses 1 and 2.Croup is breathing difficulty accompanied by a "barking" cough. Croup, which is swelling around the vocal cords, is common in infants and children and can have a variety of causes.Alternative Names: Viral croup; Laryngotracheobronchitis - acute; Spasmodic croup.Croup is a common childhood viral illness that is easily recognized because of the distinctive characteristics that children have when they become infected. Like most viral illnesses, there is no cure for croup, but there are many symptomatic treatments that can help your child to feel better faster. It, also called laryngotracheobronchitis, most commonly affects children between the ages of six months and three years, usually during the late fall, winter and early spring. Symptoms, which often include a runny nose and a brassy cough, develop about 2-6 days after being exposed to someone with this disease.Croup is the most common pediatric infection that causes stridor, accounting for approximately 15% of clinic and ED visits for pediatric respiratory infections. In North America, incidence peaks in the second year of life at 5-6 cases per 100 children. Approximately 5% of children experience more than one episode. The disease is most common in late fall and early winter but may be seen at any time of year.One of the distinctive characteristics of croup is the abrupt or sudden onset of symptoms. Children will usually be well when they went to bed, and will then wake up in the middle of the night with a croupy cough and trouble breathing. The cough that children with croup have is also distinctive. Unlike other viral respiratory illnesses, which can cause a dry, wet, or deep cough, croup causes a cough that sounds like a barking seal. Another common sign or symptom of croup is inspiratory stridor, which is a loud, high-pitched, harsh noise that children with croup often have when they are breathing in. Stridor is often confused with wheezing, but unlike wheezing, which is usually caused by inflammation in the lungs, stridor is caused by inflammation in the larger airways.The main symptoms  typically last only 2-5 days, but more rarely, they can last several weeks. Once the barking cough and difficulty breathing improve, your child may continue to have cold symptoms for 7-10 days.Although there is no vaccine (except for the flu vaccine) or medication that can prevent your child from getting croup, you can probably decrease the chance that your child will get croup by decreasing his exposure to other people that are sick. Also, strict handwashing and avoiding sharing foods and drinks can help to lessen your child's chances of getting sick.Symptoms:CroupCroup features a cough that sounds like a seal barking. Most children have what appears to be a mild cold for several days before the barking cough becomes evident. As the cough gets more frequent, the child may have labored breathing or stridor (a harsh, crowing noise made during inspiration). It is typically much worse at night. It often lasts 5 or 6 nights, but the first night or two are usually the most severe. Rarely, croup can last for weeks.  The disease that lasts longer than a week or recurs frequently should be discussed with your doctor to determine the cause.Causes and Risk factors:The parainfluenza virus is a family of viruses that accounts for 75% of cases of croup. Croup symptoms often develop a few days after the start of what appears to be an upper respiratory infection (URI), such as a cold. Most cases are caused by human parainfluenza viruses types I and II. However, other viruses, such as influenza viruses types A and B, respiratory syncytial virus (RSV), and measles, can also cause croup. As children grow older and structures in the throat and breathing tubes mature, they are less susceptible to croup. Viral croup is the most common. Other possible causes include bacteria, allergies, and inhaled irritants. Acid reflux from the stomach can trigger croup. Croup is usually (75 percent of the time) caused by parainfluenza viruses, but RSV, measles, adenovirus, andinfluenzacan all cause croup. Before the era of immunizations and antibiotics, croup was a dreaded and deadly disease, usually caused by the diphtheria bacteria. Today, most cases o are mild. Nevertheless, it can still be dangerous.Diagnosis:A doctor usually diagnoses croup from a physical examination and a medical history. During the physical examination, the doctor listens to your child's chest and back and looks for signs of inflammation or infection in the nose, ears, mouth, and throat. You will also be asked when your child's symptoms began, whether they have changed, and whether you have noticed any fever.Special exams or tests usually are not needed to diagnose the disease. But because the condition may cause difficulty breathing, a pulse oximeter may be placed on your child's finger, toe, or earlobe to check the amount of oxygen in the blood. In rare cases, an X-ray may be needed to look at the throat.Treatment:Most cases of this disease can be safely managed at home, but call your health care provider for guidance, even in the middle of the night.Cool or moist air can bring relief. You might first try bringing the child into a steamy bathroom or outside into the cool night air. If you have a cool air vaporizer, set it up in the child's bedroom and use it for the next few nights.Acetaminophen can make the child more comfortable and lower a fever, lessening his or her breathing needs. Avoid cough medicines unless you discuss them with your doctor first.You may want your child to be seen. Steroid medicines can be very effective at promptly relieving the symptoms of croup. Medicated aerosol treatments, if necessary, are also powerful.Serious illness requires hospitalization. Increasing or persistent breathing difficulty, fatigue, bluish coloration of the skin, or dehydration indicates the need for medical attention or hospitalization.Medications are used to help reduce upper airway swelling. This may include aerosolized racemic epinephrine, corticosteroids taken by mouth, such as dexamethasone and prednisone, and inhaled or injected forms of other corticosteroids. Oxygen and humidity may be provided in an oxygen tent placed over a crib. A bacterial infection requires antibiotic therapy.Increasing obstruction of the airway requires intubation (placing a tube through the nose or mouth through the larynx into the main air passage to the lungs). Intravenous fluids are given for dehydration. In some cases, corticosteroids are prescribed.Prevention: Frequent hand washing and avoiding contact with others with respiratory infections are good ways to prevent colds and croup. Immediate attention to a noisy cough may be the best prevention for croup. Give your child extra fluids and expose him or her to warm, moist air to help soothe a noisy cough. Breast-feeding provides some protection to infants against these common infections. This is probably through the transmission of maternal antibodies in the breast milk. Also, avoiding tobacco smoke may lessen the risk of infants and young children getting respiratory infections.Medicine and medications:Medications include:Corticosteroids.
  • Dexamethasone (Decadron).
  • Prednisone (Deltasone) or prednisolone (Prelone).
  • Budesonide (Pulmicort Respules).
  • Nebulized vasoconstrictors.
  • Epinephrine, racemic (microNefrin) 2.25%.
  • Epinephrine (Adrenalin).
Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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