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Croup

Croup is the common name for laryngotracheitis. This is when the voice box (larynx), trachea (windpipe) and airways from the lungs (bronchi) become infected. It's a common condition and only rarely has serious consequences.

Croup mainly affects children under the age of six. Often no treatment is needed, but sometimes medicines will be prescribed.

  • About croup
  • Symptoms
  • Complications
  • Causes
  • Diagnosis
  • Treatment
  • Prevention
  • Sources
  • Related topics

About croup

Croup is a condition in which parts of your child's respiratory (breathing) system become infected, leading to inflammation. Thick mucus is also produced. The airways from the lungs are likely to be swollen and this makes it difficult for air to move into and out of the lungs.

About three in every 100 children will get croup each year. It mainly affects children between the ages of a few months and six years old, but they are most likely to get it if they are under three years old. This is because at this age, children's windpipes and airways are smaller and so they are more likely to become narrower if they are infected. For this reason, the symptoms are usually more severe in younger children.

Children may get croup more than once. It occurs more often during the autumn and winter in the UK.

Symptoms

It's very likely that the first symptom you notice will be your child coughing. For many children, this frequently starts suddenly during the night. The cough has a very recognisable sound, similar to a dog barking. It's also been compared to the noise made by a seal. Other symptoms include:

  • harsh noise when breathing in (stridor)
  • hoarse throat
  • runny nose
  • mild fever
  • problems with breathing
  • the chest moving up and down a lot during breathing

You will probably find that your child's symptoms are worse at night.

These symptoms may be caused by problems other than croup. You should visit your GP for advice.

Complications

Croup doesn't usually last for longer than a few days. However, occasionally children who have severe croup can develop an ear infection or pneumonia (inflammation of the lungs).

If the infection is very severe, it may lead to your child not being able to breathe because the airway is too swollen. If this happens, your child will need to go to hospital for treatment. A tube will be put into your child's windpipe to provide oxygen. Your child will be under sedation for between 24 and 48 hours while this is happening. Sedation relieves anxiety and causes temporary relaxation without putting your child to sleep.

It's important that you contact your GP immediately if your child's condition gets worse or if any complications develop. You should call an ambulance for emergency help if your child can't breathe, has blueness around the mouth or if the skin around his/her neck or ribcage is drawn in.

Causes

About three-quarters of people who get croup do so as a result of a virus called parainfluenza. It may also be caused by other viruses including the respiratory syncytial virus. This is in the same family of viruses as parainfluenza and the measles virus. Very occasionally croup may be caused by bacteria or an allergic reaction.

Diagnosis

Your GP will ask about your child's symptoms and examine him/her, in particular looking at the throat to see if it's swollen. Your GP may also ask about your child's medical history. Usually this will be enough for croup to be diagnosed.

Stridor and other breathing problems may also be caused by something being lodged in the throat or by infections other than croup. If your GP isn't sure what is causing the symptoms, he or she may take an X-ray image of your child's throat and chest.

Treatment

Most children who develop croup will get better within a couple of days and won't need to have any medical treatment. In some children, the infection may last up to a week.

Self-help

It's important to make sure that your child drinks plenty of fluids so that he/she doesn't get dehydrated. Your child's symptoms will probably be better if he/she stays as upright as possible.

Steam inhalation has been used for many years to treat croup, but there is no scientific evidence to show that it actually works. However, if your child only has mild croup, you may find that it's helpful in making him/her more comfortable.

You can create a steamy atmosphere by running the hot taps in your bathroom and closing the door to keep the steam inside. It's very important that you keep your child away from the hot water and take care not to scald him/her. You can also buy air humidifiers.

Medicines

Your GP may prescribe a type of medicine called a corticosteroid. Your child is likely to receive one dose, taken by mouth, of a medicine called dexamethasone. This medicine is very effective at relieving the symptoms of croup and your child probably won't need any further medical treatment.

If your child has more severe croup, he/she may be prescribed a medicine called budesonide. However, this has to be inhaled as a gas through a mask - the process takes longer and young children may find it upsetting.

Sometimes your child may also be given an inhalation of adrenaline. This is a hormone (chemical produced by your body) that can be made artificially. It causes the airways to widen and the effect lasts for about two to three hours.

Prevention

Croup is spread by droplets in the air which are released when someone with the infection coughs or sneezes. The disease can also be passed on by touching a surface that has been contaminated. You can reduce the risk of croup by making sure your child washes his/her hands regularly. If possible keep your child away from people who have a respiratory infection.

Sources

  • Croup (updated). BMJ Clinical Evidence. http://clinicalevidence.bmj.com, accessed 6 December 2007
  • Waterston T, Helms P, Ward Platt M. Paediatrics. Understanding Child Health. 1st ed. Oxford: Oxford University Press, 1997
  • Frequently asked questions on respiratory syncytial virus (RSV). Health Protection Agency. www.hpa.org.uk, accessed 13 February 2008
  • Croup. Causes. NHS Direct. www.nhsdirect.nhs.uk, accessed 6 December 2007
  • Moore M, Little P. Humidified air inhalation for treating croup. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No: CD002870.pub2
  • British National Formulary for Children (BNFC). Bronchodilators. BMJ Publishing Group, 2007

Related topics

Pneumonia