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Croup

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VOL: 101, ISSUE: 03, PAGE NO: 30

What is it?

- Croup is the common name for laryngotracheitis (inflammation and narrowing of the larynx, trachea and bronchi caused by viral infection).

- It reduces airflow, causing breathing difficulty.

- It affects children aged six months to six years and boys are more commonly affected than girls.

- It occurs mainly in winter or early spring, usually in epidemics.

Symptoms

- Mild fever.

- A harsh ‘barking’ cough.

- Hoarseness.

- Difficult, painful breathing, especially on inhaling.

- Inspiratory stridor (rasping) on inhalation, coughing or crying - usually only seen in severe cases, but can happen when the child is sleeping or resting.

- Symptoms often worse at night.

- They usually diminish after three days, although a mild cough may persist for a further week.

- If the child has serious breathing difficulties, the soft tissues of the neck and the area below the ribcage may pull inwards during attempts to inhale; the child may also be cyanotic.

Causes

- Croup is commonly caused by the parainfluenza virus; other viruses such as measles or the influenza virus may also cause it, but do not always lead to breathing difficulties.

- It is spread through airborne droplets or by touch.

- Children born prematurely or with narrow upper airways are more prone to croup.

- Rarely, it is caused by bacteria or an allergic reaction.

- Incidence of life-threatening, bacterially mediated croup declined significantly when diphtheria and Haemophilus influenzae type B vaccines became available.

Diagnosis

- Diagnosis is on the basis of symptoms, especially the characteristic cough and appearance of the throat.

- The child should also be checked for fever, cold symptoms or recent viral illness.

- If symptoms are severe and do not respond to treatment, a neck X-ray may be necessary to rule out other conditions such as epiglottitis or a foreign object stuck in the throat.

Treatment

- Most children recover without medical treatment.

- The condition can be distressing and parents should try to keep the child calm.

- Sitting upright or carrying the child in cool fresh air can aid breathing.

- Plenty of cool drinks will prevent dehydration.

- If the child has a fever, paracetamol liquid (Calpol or Disprol, for example) or ibuprofen should be given.

- The child’s clothing can be removed if the room is warm.

- Cough medicines that cause drowsiness should be avoided.

- The child should avoid smoky environments.

Rare complications

- Severe croup may lead to life-threatening airway obstruction, when admission to hospital for ventilation is required.

- Children born prematurely or those with a history of lung disease, such as asthma, may develop severe breathing difficulties requiring hospital treatment.

- Some children show allergic reactions to the croup virus, such as redness, swelling and respiratory distress.

- Some develop secondary infections such as an ear infection or pneumonia.

Prevention

- Regular handwashing can help prevent transmission by touch.

- Avoiding contact with people with respiratory infections can help prevent airborne transmission.

Websites

Kids Health: www.kidshealth.org/parent/infections/bacterial_viral/ croup.html

NHS Direct: www.nhsdirect.nhs.uk

Prodigy: www.prodigy.nhs.uk

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