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Croup is a common childhood ailment. Typically, it arises from a viral infection of the larynx (voice box) and is associated with mild upper respiratory symptoms such as a runny nose and cough. The key symptom is a harsh barking cough. Croup is usually not serious and most children recover within a few days. In a small percentage of cases, a child develops breathing difficulties and may need medical attention.
At one time, the term croup was primarily associated with diphtheria, a life-threatening respiratory infection. Owing to widespread vaccinations, diphtheria has become rare in the United States, and croup currently refers to a mild viral infection of the larynx. Croup is also known as laryngotracheitis, a medical term that describes the inflammation of the trachea (windpipe) and larynx.
Parainfluenza viruses are the typical root cause of the infection, but influenza (flu) and cold viruses may sometimes be responsible. All of these viruses are highly contagious and easily transmitted between individuals via sneezing and coughing. Children between the ages of three months and six years are usually affected, with the greatest incidence at one to two years of age. Croup can occur at any time of the year, but it is most typical during early autumn and winter. The characteristic harsh barking of a croupy cough can be very distressing, but it rarely indicates a serious problem. Most children with croup can be treated very effectively at home; however, 1-5% may require medical treatment.
Croup may sometimes be confused with more serious conditions, such as epiglottitis or bacterial tracheitis. These ailments arise from bacterial infection and must receive medical treatment.
Causes and symptoms
The larynx and trachea may become inflamed or swollen from an upper respiratory viral infection. The hallmark sign of croup is a harsh, barking cough. This cough may be preceded by one to three days of symptoms that resemble a slight cold. A croupy cough is often accompanied by a runny nose, hoarseness, and a low fever. When the child inhales, there may be a raspy or high-pitched noise, called stridor, owing to the narrowed airway and accumulated mucus. In the presence of stridor, medical attention is required.
However, the airway rarely narrows so much that breathing is impeded. Symptoms usually go away completely within a few days. Medical treatment may be sought if the child's symptoms do not respond to home treatment.
Emergency medical treatment is required immediately if the child has difficulty breathing, swallowing, or talking; develops a high fever (103°F/39.4°C or more); seems unalert or confused; or has pale or blue-tinged skin.
Croup is diagnosed based on the symptoms. If symptoms are particularly severe, or do not respond to treatment, an x ray of the throat area is done to assess the possibility of epiglottitis or other blockage of the airway.
Home treatment is the usual method of managing croup symptoms. It is important that the child is kept comfortable and calm to the best degree possible, because crying can make symptoms seem worse. Humid air can help a child with croup feel more comfortable. Recommended methods include sitting in a steamy bathroom with the hot water running or using a cool-water vaporizer or humidifier. However, research in 2004 found that although cool-mist therapy at home or in the hospital may add to the child's comfort, it does little to treat the actual condition. The child should drink frequently in order to stay well hydrated. To treat any fever, the child may be given an appropriate dose of acetaminophen (like Tylenol). Antihistamines and decongestants are ineffective in treating croup. All children under the age of 18 should not be given aspirin, as it may cause Reye's syndrome, a life-threatening disease of the brain.
If the child does not respond to home treatment, medical treatment at a doctor's office or an emergency room could be necessary. Based on the severity of symptoms and the response to treatment, the child may need to be admitted to a hospital.
For immediate symptom relief, epinephrine may be administered as an inhaled aerosol. Effects last for up to two hours, but there is a possibility that symptoms may return. For that reason, the child is kept under supervision for three or more hours. Steroids (corticosteroids) such as prednisone may be used to treat croup, particularly if the child has stridor when resting.
Of the 1-5% of children requiring medical treatment, approximately 1% need respiratory support. Such support involves intubation (inserting a tube into the trachea) and oxygen administration.
Botanical/herbal medicines can be helpful in healing the cough that is commonly associated with croup. Several herbs to consider for cough treatment include aniseed (Pimpinella anisum), sundew (Drosera rotundifolia), thyme (Thymus vulgaris), and wild cherry bark (Prunus serotina). Homeopathic medicine can be very effective in treating cases of croup. Choosing the correct remedy (a common choice is aconite or monkshood, Aconitum napellus) is always the key to the success of this type of treatment.
Croup is a temporary condition and children typically recover completely within three to six days. Children can experience one or more episodes of croup during early childhood; however, croup is rarely a dangerous condition.
Croup is caused by highly transmissible viruses and is often difficult to impossible to prevent.
Kirn, Timothy F. "Cool Mist Therapy is Losing Credibility for Croup: Steroids or Even Epinephrine May Be Needed." Pediatric News March 2004: 10-11.
Diphtheria — A serious, frequently fatal, bacterial infection that affects the respiratory tract. Vaccinations given in childhood have made diphtheria very rare in the United States.
Epiglottitis — A bacterial infection that affects the epiglottis. The epiglottis is a flap of tissue that prevents food and fluid from entering the trachea. The infection causes it to become swollen, potentially blocking the airway. Other symptoms include a high fever, nonbarking cough, muffled voice, and an inability to swallow properly (possibly indicated by drooling).
Glucocorticoid — A hormone that helps in digestion of carbohydrates and reduces inflammation.
Larynx — Commonly called the voice box, it is the area of the trachea that contains the vocal cords.
Stridor — The medical term used to describe the high-pitched or rasping noise made when air is inhaled.
Trachea — Commonly called the windpipe, it is the air pathway that connects the nose and mouth to the lungs.
a condition resulting from acute partial obstruction of the upper airway, seen mainly in infants and young children; characteristics include resonant barking cough, hoarseness, and persistent stridor. It may be caused by a viral infection (usually a parainfluenzavirus), a bacterial infection (usually Staphylococcus aureus, Streptococcus pneumoniae, or Streptococcus pyogenes,) an allergy, a foreign body, or a tumor.
bacterial croup (membranous croup) (pseudomembranous croup) bacterial tracheitis.
1. Acute obstruction of upper airway in infants and children characterized by a barking cough with difficult and noisy respiration.
2. Laryngotracheobronchitis in infants and young children caused by parainfluenza viruses 1 and 2.
3. An anatomic term in veterinary medicine referring to the topline located between the base of the tail and forward to the cranial aspect of the wings of the ilium in dogs and horses.
[Scots, probably from A.S. kropan, to cry aloud]
croup(krldbomacp) acute partial obstruction of the upper airway, usually in young children and caused by a viral or bacterial infection, allergy, foreign body, or new growth; characteristics include barking cough, hoarseness, and stridor.croup´ouscroup´y
bacterial croup , membranous croup, pseudomembranous croup bacterial tracheitis.
A pathological condition of the larynx, especially in infants and children, that is characterized by respiratory difficulty and a hoarse, brassy cough.
croup′ous (kro͞o′pəs), croup′y adj.
The rump of a beast of burden, especially a horse.
Etymology: Scot, to croak
an acute infection of the upper and lower respiratory tract that occurs primarily in infants and young children 3 months to 3 years of age after an upper respiratory tract infection. It is characterized by hoarseness; irritability; fever; a distinctive harsh, brassy cough; persistent stridor during inspiration; and dyspnea and tachypnea, resulting from obstruction of the larynx. Cyanosis or pallor occurs in severe cases. The most common causative agents are the parainfluenza viruses, especially type 1, followed by the respiratory syncytial viruses and influenza A and B viruses. Croup can also be caused by bacteria, allergies, and inhaled irritants. Also called acute laryngotracheobronchitis, angina trachealis,exudative angina,laryngostasis. Compare acute epiglottitis. croupous, croupy, adj.
observations Transmission occurs through infection with airborne particles or with infected secretions. Leukocytosis with an increased proportion of polymorphonuclear cells may be present at first, followed by leukopenia and lymphocytosis. A lateral neck x-ray film shows subepiglottic narrowing and a normal-sized epiglottis, which differentiate the condition from acute epiglottitis. Onset of the acute stage is rapid, usually occurs at night, and may be precipitated by exposure to cold air. The child's condition often improves in the morning, but it may worsen at night.
interventions Routine treatment consists of bed rest, adequate fluid intake, and alleviation of airway obstruction to ensure adequate respiratory exchange. Children with mild infections are usually managed at home with supportive measures, such as use of acetaminophen to reduce fever and vaporizers, humidifiers, or steam from hot running water in an enclosed bathroom to reduce the spasm of the laryngeal muscles and to free secretions. Hospitalization is indicated for children with dehydration; progressive stridor and respiratory distress; and hypoxia, cyanosis, or pallor. Endotracheal intubation and tracheostomy may be necessary. Humidity and oxygen are usually prescribed. The vital signs are continuously monitored; changes in pulse and respiration may be early signs of hypoxia and impending airway obstruction. Fluids are often given intravenously to reduce physical exertion and the possibility of vomiting, with its attendant increased risk of aspiration. Corticosteroids and inhaled racemic epinephrine are often used. Other drugs, such as expectorants, bronchodilators, and antihistamines, are rarely used, and sedatives are contraindicated because they exert a depressant effect on the respiratory tract.
care considerations The primary focuses of care are to ease breathing by providing humidity and to monitor continuously for signs of respiratory distress and impending airway obstruction, with intubation and tracheostomy equipment kept readily available. To conserve the child's energy and to reduce apprehension, the health care provider encourages rest, disturbs the child as little as possible, remains in attendance, provides comfort with a familiar toy or other device, and encourages parental involvement whenever possible. Fever is usually reduced by the cool atmosphere of the mist tent; antipyretics are given as needed. To prevent chilling, frequent changes of clothing and bed linen are often necessary in the humid environment. The health care provider also explains the condition to the parents and discusses appropriate care after discharge, including continued use of humidity and ensuring of adequate hydration and proper nutrition. In most children the condition is relatively mild and runs its course in 3 to 7 days. The infection may spread to other areas of the respiratory tract and may cause complications, such as bronchiolitis, pneumonia, and otitis media. The most serious complication is laryngeal obstruction, which may cause death. If a tracheostomy is required, as may happen with a small percentage of children, other complications, such as infection, atelectasis, cannula occlusion, tracheal bleeding, granulation, stenosis, and delayed healing of the stoma, may develop.
croupAcute laryngotracheobronchitis, angina trachealis, laryngostasis Pediatrics A heterogeneous group of acute infections, which cause upper-airway obstruction in children Epidemiology Annual incidence–3/100 children < 6 yrs–US; 1.3% require hospitalization Etiology Parainfluenza type 1, less often type 2 and 3, RSV, influenza virus, rubeola, adenovirus, Mycoplasma pneumoniae Clinical Brassy, seal-like barking or 'croupy' cough accompanied by inspiratory stridor and hoarseness, 2º to intense edema, laryngeal mucus, subglottic stenosis, progressive or episodic dyspnea, tachypnea, cyanosis, sternal and intercostal retractions, dysphagia, low-grade fever, chills, recent URI, ↓ breath sounds, restlessness DiffDx Angioneurotic edema, bacterial tracheitis, epiglottitis, foreign body aspiration, retropharyngeal abscess Management Dexamethasone, prednisolone, budesonide–nebulizer–effective for croup, mist tents, vaporizers, antibiotics, decongestants, cough suppressants, pain medication, fluids, nebulized racemic epinephrine; hospitalization if stridor
1. Laryngotracheobronchitis in infants and young children caused by parainfluenza viruses 1 and 2.
2. Any infection of the larynx in children, characterized by difficult and noisy respiration and a hoarse cough.
[Scots, probably from A.S. kropan, to cry aloud]
croupInflammation and swelling of the main air tubes to the lungs (laryngotracheobronchitis) affecting young children and causing difficult, harsh, noisy and painful breathing and a typical ‘barking’ cough.
n viral respiratory ailment that afflicts children ages 3 months to 3 years old; symptoms include but are not limited to fever, dry barking cough, dyspnea, and tachypnea. Also called
angina trachealis, exudative angina, or
angina trachealis, exudative angina, or
1. the muscular area around and above the base of the tail in the horse.
2. acute obstruction of the larynx caused usually by allergy or respiratory infection. Used with reference to children and chickens.
Patient discussion about croup
Q. Is this croup? My one year old son has a terrible cough. Each time he coughs its load and long. I am very worried. Is this croup and if so how is it treated?
A. Here is a video that explains about croup and how to treat it:More discussions about croup