by Kimberly Allen RN
Croup is an infectious disease that involves the larynx, trachea and the bronchial tubes in the upper airways of the lungs. Croup usually develops in children between 3 months and 5 years of age however, it can develop at any age. Approximately 15% of children develop croup. Boys are 50% more likely to develop croup than girls. Croup is responsible for at least 5% of pediatric hospitalizations. Croup can occur at any time but is more common between October and March.
Croup is usually caused by a virus however, it can be caused by bacteria, allergies, or if you breathe in the irritants as well as acid reflux. The parainfluenza virus is the most common virus that is responsible for croup however other viruses including those responsible for the common cold, measles and adenovirus. Before vaccines croup was usually caused by diptheria bacteria making it one of the most deadly of the childhood illnesses. Fortunately with the development of vaccines and improved antibiotics croup caused by diptheria is rare and can be treated much better than in the past.
Croup is highly contagious and is transmitted in the moisture droplets of infected children. The infected droplets are usually coughed or sneezed into the air and then either inhaled by other children in close proximity to the infected child or they land on objects like toys and door knobs that other children touch with their hands and then they touch their eyes, nose and mouths with those hands.
There are 2 very distinct manifestations of croup, a harsh barking cough with hoarseness and a sore throat as well as a fever. The other less common manifestation is known as “acute spasmodic croup”. With this form of croup children appear completely well when put to bed but awaken in the middle of the night with the same barking cough and harsh, raspy breathing called stridor. there is no fever or sore throat seen in this form and the cough resolves with in 8-10 hours of onset. This on/off pattern will continue for several nights before transitioning to symptoms that are more like a common cold and the child will then have a “wet” cough for several days. The degree of narrowing of the airway determines the severity of symptoms.
Most cases of croup today are mild and can be treated at home, however if your child should start making high pitched noisy sounds when breathing, struggles to breathe or develops a bluish gray tint of the skin surrounding the mouth and nose or in the fingernail beds and has a fever over 103F you should contact your Dr immediately.
Mild cases of croup will resolve with use of a humidifier and lots of fluids. Tylenol can be given for fever and comfort. Do not give aspirin to children. However, if the symptoms worsen the Dr may prescribe medications such as corticosteroids or epinephrine to help open the airways. The Dr will only prescribe antibiotics if the infection is caused by bacteria. Children with severe croup may require hospitalization and treatment with humidified oxygen in a “croup tent”.
The best way to prevent croup is to take the same precautions you would take to avoid colds and flu. The most important being frequent handwashing. Also teach children to cough and/or sneeze into the crook of their elbow. It is also important that your childs immunizations are current especially the diptheria, measles, and Hib vaccines as these can cause some of the most dangerous forms of croup.
Croup can be very scary for children so it’s important to hold them and speak softly, sing a lullaby or give them their favorite blanket or toy. Keeping your child calm can reduce the severity of bronchial spasms.