Why do children develop croup?
A child’s larynx is much narrower than that of an adult, and the mucous membrane under the vocal folds is loose and rich in blood vessels. With viral inflammation, it swells, and even a slight thickening sharply reduces the lumen. The air passes with force, a characteristic noisy inhalation occurs. At night, a horizontal position, dry air and natural diurnal changes are added to this, so attacks most often begin after midnight. The causative agents are common respiratory viruses, including parainfluenza and influenza viruses. With age, the larynx becomes wider, and after five to six years the croup usually stops.
- Narrow larynx and loose mucous membrane in children
- Edema of the subglottic space
- Viral infections as the main cause
- Nocturnal worsening
- Age at risk: from 6 months to 5 years
- Seizures stop with age
Symptoms
Usually a day or two before the attack, a runny nose, cough and slight fever appear. Then the voice becomes hoarse, the cough becomes rough, barking, similar to the sound that a seal makes. As the edema increases, a noisy inhalation occurs: at first only with crying and anxiety, then at rest. The child gets scared, cries, and this completes the circle, because anxiety intensifies the narrowing. Important indicators of severity are whether there is a noise when inhaling in a calm state, whether the intercostal spaces and the fossa above the sternum are retracted, what color the skin is and whether the child can drink and speak.
- Hoarseness of voice
- Rough barking cough
- Noisy breathing that gets worse at night
- Anxiety and crying that worsen the attack
- Retraction of the compliant areas of the chest
- Runny nose and low temperature the day before
What to do before the doctor arrives
The first and most important thing is to calm down yourself and calm the child: screaming and crying increase the narrowing of the larynx. Take the baby in your arms, hold him upright, and speak calmly. Provide access to cool, moist air: open a window, go out onto the balcony, or in hot, dry weather you can turn on the humidifier. Offer warm drinks in small sips. Do not force your child to lie down if he finds it easier to sit. Absolutely do not do steam inhalations over a pan and hot steam - this risks burns and worsening. Do not give cough suppressants or use a nebulizer with solutions unless directed by a doctor.
- Remain calm and reassure the child
- Hold vertically in your arms
- Cool moist air, ventilation
- Warm drinks in small portions
- Do not use steam inhalations over a saucepan
- Do not give antitussives unless prescribed
- Call an ambulance if your breathing is noisy at rest
Treatment
The main drug for false croup is a glucocorticoid, which the doctor prescribes orally, intramuscularly or by inhalation through a nebulizer. It quickly relieves swelling of the mucous membrane, and the condition improves within a few hours. In case of pronounced narrowing, inhalation of adrenaline is used in the emergency department under the supervision of a doctor. Antibiotics are not needed for viral croup and are prescribed only for proven bacterial infection. Antitussive and expectorant drugs do not improve the course, and sometimes worsen it. A child with severe difficulty breathing is hospitalized for observation because the condition may worsen again.
- Glucocorticoid as prescribed by a doctor
- Inhalation of adrenaline for severe constriction, in the clinic
- Drink plenty of fluids and rest
- Antipyretics for poor temperature tolerance
- Avoiding antibiotics for viral infections
- Hospitalization for severe cases and repeated attacks
Prevention and when it is not croup
There is no specific prevention, but the usual measures help: hand washing, limiting contact with sick people, an annual flu shot, stopping smoking in the house, maintaining cool and humid air in the bedroom. If attacks recur frequently, the child should be seen by an ENT doctor and an allergist. It is important to remember that not every noisy breath is a false croup. A sudden onset in a healthy child without a runny nose may indicate a foreign body. High temperature, excessive salivation, inability to swallow and forced posture indicate possible epiglottitis, which requires emergency help.
- Hand hygiene and limiting contact during ARVI
- Annual flu shot
- Stop smoking indoors
- Cool damp air in the bedroom
- Examination by an ENT doctor for repeated attacks
- Suspicion of a foreign body with sudden onset
- Epiglottitis - drooling, inability to swallow, call 103