CROUP

Croup is a condition which happens in young children. It affects the windpipe (the trachea) and the bronchi (the tubes which branch off the trachea to the lungs). Croup is most common among children aged between 3 months and 3 years of age with symptoms brought on by inflammation of the respiratory tract and the airways.

There are two different types of croup: viral croup (also known as laryngotracheitis) is caused by infection and spasmodic croup which occurs when no infection is present. Viral croup tends to develop over the course of several days while spasmodic croup comes in short bursts.

Signs and symptoms

The main symptom of croup is a high-pitched, harsh sound known as stridor which is heard when the baby breathes in. Another common symptom is a barking cough and additional symptoms include:

• Fever
• Feeling and sounding hoarse
• Cold-like symptoms, such as a sore throat and runny nose
• Breathing difficulties

Stridor, the high-pitched noise, is usually made worse when the baby coughs or cries. If the noise is present when the baby is calm, this may indicate that the airway is constricted.

The symptoms are often sufficient for doctors to diagnose croup and they will usually examine the child and listen to their chest and breathing. It is important to do this to rule out any underlying respiratory conditions.

In most cases, croup is a mild condition but if your baby has severe symptoms, such as difficulty breathing, rapid breathing and heart rate, high fever and tight skin around the ribs and chest, seek urgent medical attention.

Causes

Most cases of croup are viral and they are caused through infection by the parainfluenza virus (in most cases type 1 and type 3). This usually occurs during the autumn months but it is possible for other bacterial and viral infections to cause croup.

Breathing difficulties and respiratory symptoms are caused by the body's inflammatory reaction to the infection. Croup is more common in children because their airways are smaller and less tolerant of the response.

Less common causes of croup include inhaling chemicals, allergies and acid reflux.

Treatment

Treatment for croup will depend on the severity of the symptoms. In some cases, treatment may just involve inhaling a cool mist as was done in the olden days when treatment options were limited. Today, hospitals use the same concept but have modern breathing equipment to deliver the same treatment using 'blowby apparatus' to ease symptoms. A hot bath or inhaling steam may also be helpful.

In some cases, no treatment may be required but mild symptoms may be treated with a short dose of low strength steroids.

If symptoms are moderate or severe a nebuliser may be required and oxygen can be inhaled using a mask. Children with severe croup are usually hospitalised so doctors can keep an eye on their condition, but they are generally allowed to go home after 24-48 hours and it is very rare for intubation to be needed.

Prognosis

Croup is usually a mild condition which clears up without intensive treatment. However, complications are possible and the condition can be fatal in very rare cases when the airways become completely blocked.