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Croup Cough - Symptoms & Treatment

The term croup does not refer to a single illness, but rather a group of conditions involving inflammation of the upper airway that leads to a cough that sounds like a bark, particularly when a child is crying.

A severe inflammation and obstruction of the upper airway. croup can occur as acute laryngotracheobronchitis (most common), laryngitis, and acute spasmodic laryngitis. It must always be distinguished from epiglottitis.

Croup is a childhood disease affecting boys more often than girls (typically between ages 3 months and 3 years) that usually occurs during the winter. Up to 15% of patients have a strong family history of croup. Recovery is usually complete.

The term spasmodic croup refers to a condition similar to viral croup, except that there are no accompanying symptoms of an infection. The cough frequently begins at night with a sudden onset. The child usually has no fever with spasmodic croup. The symptoms are treated the same for either form of croup.

Causes

Croup usually results from a viral infection. Parainfluenza viruses cause two­thirds of such infections; adenoviruses, respiratory syncytial virus (RSV), influenza and measles viruses, and bacteria (pertussis and diphtheria) account for the rest.

Signs and symptoms

Signs and symptoms of croup may include:

• Mild to moderate difficulty with breathing, especially noisy when inhaling
• Fever
• Hoarse voice

Croup 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. Croup that lasts longer than a week or recurs frequently should be discussed with your doctor to determine the cause.

Contagiousness

Croup tends to occur in outbreaks in the winter and early spring when the viruses that usually cause it peak. Many children who come in contact with the viruses that cause croup will not get croup, but will instead have symptoms of a head cold.

Diagnosis

When bacterial infection is the cause, throat cultures may identify organisms and their sensitivity to antibiotics as well as rule out diphtheria. A neck X-ray may show areas of upper airway narrowing and edema in subglottic folds; laryngoscopy may reveal inflammation and obstruction in epiglottal and laryngeal areas.

In evaluating the patient, consider foreign-body obstruction (a common cause of croupy cough in young children) as well as masses and cysts.

Treatment

For most children with croup, home care with rest, cool humidification during sleep, and antipyretics, such as acetaminophen, relieve symptoms. However, respiratory distress that interferes with oral hydration requires hospitalization and parenteral fluid replacement to prevent dehydration.

If bacterial infection is the cause, antibiotic therapy is necessary. Oxygen therapy may also be required.

Alternative treatment

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.

Prevention

Frequent hand washing and avoiding contact with others with respiratory infections are good ways to prevent colds and croup.

The diphtheria, Haemophilus influenzae (Hib), and measles vaccines protect children from some of the most dangerous forms of croup.