It is 3 a.m. and Patrick’s parents are suddenly awakened by the sound of their 2-year-old child’s deep, barking cough. It occurs in spasms and resembles the grunting of a seal. Patrick has croup, a syndrome that affects numerous children of all ages throughout the winter in North America. The medical term for croup is laryngo-tracheo-bronchitis. This syndrome is primarily a viral illness that causes swelling of the air passageways beneath the vocal cords and increased secretion of mucus. The most common causes are viral infections, though occasionally allergies have been involved.
The viruses that can cause croup are primarily influenza and para- influenza viruses, respiratory syncytial virus (RSV), and, rarely, adenovirus, and rhinovirus. The seasons will affect the number and type of cases in the community. For example, para-influenza related cases occur most often in the fall and early winter; RSV-related croup commonly occurs throughout mid-winter and spring.
Though croup can affect children of all ages, it most frequently involves children between the ages of 6 months and 3 years.Besides having a barky cough, children with this illness usually have stuffy and runny noses, watery eyes, and fever before the development of the cough. As the swelling under the vocal cords progresses, the child may also develop stridor, which is a coarse, crowing-like sound heard when the child inhales. At first the sound may be apparent only between coughing spells or while crying. If the swelling progresses, it may be heard at rest, which implies a more serious respiratory problem and the possible need for hospitalization.
The majority of children will have a mild case that will run its course and require only treatment to help reduce the swelling and thin the secretions in the tracheal bronchial tree or air passageways. This is more easily accomplished through the use of a cool air humidifier and by encouraging the child to drink large amounts of fluid to insure adequate hydration. Hot air vaporizers are not suggested because of the potential for burns and scalds. Taking the child out in the cold night air for 20 minutes has also been helpful. The duration of the illness is usually 5-7 days.
If these measures fail, the parents should call or have their child see his physician who may decide to either admit the child or use outpatient medication to reduce the swelling beneath the vocal cords and in the tracheal bronchial area. If the symptoms are not too severe, a trial of a fast acting steroid may be used to reduce the swelling that is usually apparent beneath the vocal cords. If symptoms do not improve or deteriorate, hospitalization is necessary for more aggressive treatment. Antibiotics are generally not helpful for viral infections and are not used unless there is also a bacterial infection such as ear infection, or bacterial pneumonia.
Though most croup episodes in children are self-limiting viral illnesses, parents should not hesitate to consult their physician about the severity of their child’s illness as well as the possibility of a different diagnosis.