Download Croup – in detail

Croup – in detail
Croup is an infection of the throat and windpipe (larynx
and trachea) that results in a hoarse voice, noisy
breathing and a harsh, barking cough. Children with
croup usually have a ‘cold’ first, then (particularly when
the air is colder, such as at night-time) the croupy
breathing and cough start. Most of the children who have
croup are under five years old. Because they are small,
their airway is narrow; when infection causes swelling of
its lining, it becomes even narrower causing difficulty
when the child is breathing in.
It is not usually possible to prevent croup, since many
viruses can cause it and there is no immunisation
available against most of them. True influenza (flu) can
also cause croup and, in this instance, immunisation may
be effective. However, influenza vaccine is only
recommended for children with underlying diseases, like
asthma and fibrocystic disease. Antibiotics don’t work,
because viruses don’t respond to antibiotics.
Often the child will have been mildly unwell for a couple of
days with a runny nose, cough and slight temperature.
Then the child wakes during the night with a barking
cough, hoarse voice and difficulty breathing. This can last
a couple of hours, and reappear for the next couple of
nights. Some older children (aged between three and
eight years) may develop occasional croup, even when
they don’t have a cold.
If the child is obviously not well, has a high fever, has
difficulty breathing, makes a noise while breathing
(particularly a snoring sound on breathing out, even when
resting) and has difficulty swallowing, they need urgent
medical assessment. The problem could be due to
inflammation of the epiglottis (epiglottitis) and not croup.
Also, any child who suddenly starts to cough or has noisy
breathing during the daytime, without being unwell, may
be choking on something. Some of these conditions,
which mimic croup, are difficult for parents to distinguish –
if there is any doubt, see a doctor urgently.
Symptoms
The symptoms of croup include:
•
Noisy breathing (inspiratory stridor) – a high
pitched sound
•
Harsh, barking cough
•
Hoarse voice
•
Difficulty breathing – depending on the
severity of the illness.
Serious signs need urgent medical care
If the child’s symptoms don’t settle quickly, with
comforting and once they stop crying, the child needs to
be seen by a doctor urgently. Features which indicate that
the windpipe obstruction is getting worse, and which
demand urgent medical attention, include:
•
Increasing respiratory rate.
•
Restlessness, anxiety and sweating.
•
Continuous soft stridor (noisy breathing).
•
Bluish tinge to the lips.
•
‘Caving in’ of the soft tissues of the neck and
between the ribs when the child tries to
breathe in.
In these situations, the child should be taken to the
nearest children’s hospital or to a hospital with paediatric
expertise – urgently.
Protecting children from croup
The viruses that cause croup are very similar to those of
the common cold. They start to be infectious with the first
signs, such as a runny nose and cough, and remain
infectious for up to five days. Most people (including
children) who get these viruses will not develop croup.
About one in 10 children who get the virus infection will
get croup.
Other possible causes of respiratory
distress
Home remedies for mild croup
You can treat mild croup at home, if your child has no
breathing problems or noisy breathing when they are not
crying. Suggestions include:
•
Comforting is very important. Having a croupy
cough and noisy breathing frightens children,
and being scared makes the situation worse.
•
Offer frequent drinks (unless they are having
difficulty swallowing).
•
If your child has a high fever or sore throat,
and your doctor is sure that this is not
epiglottitis, give them paracetamol (in the
dose appropriate to their age).
•
Increased moisture in the air may help your
child to feel better, although it has not been
shown to get rid of the illness any more
quickly. Sitting in the bathroom with hot water
flowing, or using a vaporiser, may be useful.
Beware of scald injuries.
Professional treatment
Mild croup generally settles within a couple of hours and the
child goes back to sleep. If the croup doesn’t settle, or if your
child becomes more distressed or unwell, take them to your
doctor or children’s hospital straight away. Medical treatment
for croup may include:
•
Oral steroids – or inhaled steroids, if the oral
steroids are not tolerated. Steroids decrease the
length of the croup episodes. They also reduce
the number of children who need admission to
hospital.
•
Nebulised adrenalin – in the case of severe
symptoms, nebulised adrenalin may also be
given (in hospital) to relieve the swelling in the
windpipe until the steroids work.
•
Antibiotics do not help because the infection is
caused by a virus.
See over …
Where to get help
•
•
•
•
Your doctor
Emergency department of your nearest
hospital
Maternal and Child Health Services Tel. (03)
9853 0844 after hours; 1800 134 883
In an emergency, always call an ambulance
Tel. 000
Things to remember
•
•
•
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Croup is a viral infection of the throat and
windpipe (larynx and trachea) that causes
noisy breathing, a hoarse voice and a harsh,
barking cough.
Croup usually starts as a ‘cold’ for a few days,
then the noisy breathing and cough starts
(usually at night).
You can treat mild croup at home, if your child
has no breathing problems or noisy breathing
when they are not crying.
Medical treatment of croup may include
hospitalisation, steroids and nebulised
adrenalin.
If there are signs of increasing windpipe
obstruction, seek urgent medical help.
Date Created: July 2001
Last Reviewed: July 2001
This page has been produced in consultation with, and approved by, the
Child and Youth Health. The Better Health Channel is part of the
Department of Human Services, Victoria