Croup (Acute Laryngotracheobronchitis)
Croup is an acute illness of early childhood that affects the upper and lower respiratory passages Caused by a virus, it frequently follows a cold or the flu. The disorder occurs in the late fall and winter as a rule, and generally lasts no more than a week.
Typically, croup is characterized by hoarseness, wheezing, a light barking cough, and difficulty in breathing -- all consequences of an infection of the larynx and swelling of the vocal chords. A low-pitched, harsh, raspy noise, called stridor, occurs when air passes through the swollen windpipe and over the inflamed vocal cords. Coughing attacks range from mild to severe and tend to be worse at night. Prolonged coughing can continue for half an hour and may end with vomiting.
Diagnostic Studies and Procedures
Croup can usually be diagnosed over the telephone simply by describing the symptoms and cough. In a doctor's office, it is easily identified by listening to the child's breathing and coughing.
Medical Treatments
Medicines are not given for croup unless there is a secondary bacterial infection. In such a case, an antibiotic will be prescribed. Children who develop severe complications, such as threatened airway blockage or pneumonia, require hospitalization. Inhaled epinephrine may be administered to reduce swelling of the air passage.
Alternative Therapies
Caring for a child with croup requires calmness to quell the anxiety of the youngster -- a task that can be difficult if parents themselves are anxious. Relaxation techniques are useful in helping parents overcome their own alarm. Other approaches include:
Aromatherapy. Add a few drops of ginger extract to a warm bath to loosen mucus. After bathing, wrap the child in a heavy towel or light blanket, and put her lo bed.
Herbal Medicine. Herbalists suggest drinking diluted echinacea extract, or gargling with fenugreek tea. Another remedy is a hot onion pack on the back or chest. To prepare one, wrap sliced onions with flannel or other cotton cloth and top with a heating pad or hot water bottle. Make sure that the heat source is not so hot as to cause a burn.
Self-Treatment
Croup is almost always treated at home by using a cool-mist humidifier or a steam vaporizer in the child's room around the clock. In fact, this practice during a cold or flu can often prevent the onset of croup. Do not add menthol or aromatic camphor oils to the vaporizer because they can irritate already inflamed tissues.
During a coughing attack, increase the air moisture by transforming a bathroom into a steamroom. Turn on hot water in the shower and close the bathroom door until the room is dense with steam. Do this as soon as an attack begins, and stay in the bathroom with the child until the attack is over. A frightened child can be comforted by assurances that the steam will make breathing much easier.
Another approach is to pour hot water into a pitcher or bowl and have the child lean over it with a towel draped on the head to make a kind of lent. Never hold a child over hot steam coming from a kettle on the stove; this can result in serious scalding.
A child with croup can breathe more easily sitting up than lying down; use extra pillows or a bolster at night.
Reduce milk and milk products to a minimum during the illness, and offer large amounts of broth and other warm, clear fluids to loosen mucus trapped in the airways. Apple juice and tea with honey and lemon are also
helpful for loosening mucus.
Because crying can trigger an attack, even an older child will benefit from being held and cuddled. Use distractions such as storytelling and singing. Also, a few minutes of fresh air can sometimes end an episode.
The effect of passive tobacco smoke can transform croup from a manageable illness into a medical emergency. Therefore, no one should be permitted to smoke indoors when a child has croup. If this rule is unenforceable, keep smoking confined to one designated j room, keep the door closed, open the windows from time to time, and make this room off-limits to the child.
Other Causes of Croup-like Symptoms
Asthma can sometimes produce coughing and a choking sensation, as can tonsillitis and other respiratory infections. In unusual cases, a foreign object lodged in a child's throat may create a barking cough and difficult breathing. This circumstance can be confirmed by an X-ray. Pertussis, or whooping cough, also causes severe, harsh bouts of coughing that often end in vomiting. These coughing attacks can occur periodically for several months.