Croup

• Cough that sounds like a barking seal
• Stridor (an abnormal, high-pitched, harsh, raspy sound during inspiration)
• Hoarseness of voice
• Sore throat
• Runny nose
• Fever (100-103°F)
• Difficulty in breathing or shortness of breath
• Congestion
• Difficulty in swallowing
• Increase in respiratory rate
• Increase in heart rate
• Nasal flaring (widening of nostrils while breathing)

The symptoms of croup usually become worse at night.

In some cases, children may also experience:

• Cyanosis - a condition in which skin, lips, or nails turn blue
• Skin rashes
• Conjunctivitis
• Dehydration

The symptoms of croup last for 4-7 days but can prolong for as long as 2 weeks.

Interesting facts!

The name “croup” is derived from the word “kropan,” which refers to crying out in a hoarse voice.

The sound, called "stridor," has been noted to resemble the breathing of the Star Wars character Darth Vader.

Croup is primarily a viral infection, although some bacteria can also contribute to its development. The various causes are discussed as follows:

1. Virus
The common viruses that can cause croup include:

• Parainfluenza virus
• Influenza A and B
• Measles
• Adenovirus
• Respiratory syncytial virus (RSV)

Here are four habits that should be followed to prevent viral infections.

2. Bacteria
Croup often begins as a viral infection, which may later become complicated due to secondary bacterial growth from organisms such as:

• Corynebacterium diphtheriae
• Staphylococcus aureus
• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis

What do these viruses and bacteria do?
These pathogens cause swelling of the larynx (voice box), trachea (windpipe), and large airways. The swelling results in partial obstruction of the airway, leading to difficulty in breathing and other characteristic symptoms of croup.

How does the infection spread?
Viral croup can be transmitted through coughing, sneezing, and other respiratory secretions such as droplets and mucus. Children can contract croup through:

• Contact with the virus in the air after an infected person has coughed or sneezed
• Handling an infected person
• Touching contaminated surfaces

Children with croup are contagious for at least three days after the onset of the infection.

• Age: Almost all cases of croup are seen in children between the ages of 3 months and 5 years due to the small diameter of the windpipe.
• Season: Children are more likely to develop croup during late autumn or early winter due to the increased occurrence of viruses, such as colds and flu, at this time of year.
• Family History: Children with a family history of croup or other respiratory illnesses, such as asthma, have a higher chance of developing it.
• Gender: Males are more prone to croup than females.
• Geographical Location: Individuals living in densely populated areas have a higher chance of developing croup due to its highly contagious nature.
• Traveling: Frequent traveling increases the risk of croup due to increased exposure in crowded places such as playgroups, schools, offices, buses, and flights.
• Poor Hand Hygiene: Since croup is primarily a viral illness, poor hand hygiene increases its risk.
• Passive Smoking: Children who are exposed to passive smoking are more prone to develop croup.
• Inadequate Vaccination: Children who are not vaccinated for influenza are at a higher risk of contracting croup infection.
• Low Immunity: Children with low immunity are more susceptible to bacterial and viral infections that can cause croup.

Croup is primarily diagnosed based on clinical symptoms and physical findings.

The doctor may listen to your child's breathing with a stethoscope for wheezing and decreased breath sounds. A visual examination of the throat may reveal redness in the upper airway.

The following tests can be performed as needed:

• Complete Blood Count (CBC)
  Blood tests do not confirm croup but provide indications of the disease. CBC is used to assess infection. The white blood cell count may suggest the presence of a virus.
• Pulse Oximetry
  This test measures the oxygen level in the blood, typically done by placing a clip-like device called a probe on a body part, such as a finger or earlobe. This monitoring is helpful in assessing the need for supplemental oxygen. Keeping a pulse oximeter at home can aid in better assessment of oxygen levels.
• Laryngoscopy
  This involves examination of the voice box and vocal cords using a camera. It is not used for routine examinations but may be necessary in the following circumstances:
  - Failure of other diagnostic methods
  - Presence of acute distress in the child
  - Confirmation of bacterial tracheitis (a complication of croup)
• Neck X-ray
  An X-ray of the neck can be considered for observing features like tapering of the upper windpipe or thickened trachea. However, it is not routinely used.

We prioritize the safety and comfort of our patients during laboratory procedures, offering the convenience of scheduling lab tests from home.

1. Practice hand hygiene
   Most cases of viral croup can be prevented by washing hands with soap and water for at least 30 seconds for both the child and the parents:
   • After using the toilet
   • Before and after eating
   • After handling the vomit of an infected patient
   • After changing the child's diapers
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2. Maintain hygiene
   Bacterial croup spreads through contaminated surfaces. Practicing good hygiene is the best way to prevent infection. The following measures can be taken to ensure cleanliness:
   • Keep nails short and avoid wearing false fingernails, nail extenders, nail polish, and jewelry as they restrict adequate cleaning of hands.
   • Clean surfaces and objects that have been exposed to vomit or feces.
   • Wear disposable gloves and masks while handling feces or vomit of infected individuals.
   • Use disposable paper towels to dry hands; avoid cloth towels as bacteria can survive on them.
   • Keep kitchen counters, toys, toilet seats, and nappy change tables clean to avoid the growth of bacteria and viruses.
3. Isolate the patient
   As croup is highly contagious, isolating the patient helps prevent the spread of infection. Children who exhibit symptoms such as stridor (an abnormal, high-pitched, musical breathing sound), hoarseness, rhinorrhea (runny nose), and sore throat should not return to childcare until 24 hours after symptoms have resolved.
4. Ensure vaccination
   Croup is caused by several viruses and bacteria. Some viral infections that lead to croup, such as influenza, can be prevented through proper vaccination. Here are some vaccines that can benefit your child. Read to Know

The treatment of croup generally depends upon the severity of the condition.

Antibiotics are usually ineffective as the condition is primarily caused by viruses.

There is no proven role of cough medicines and decongestants.

The medications used in managing symptoms include:

• Saltwater nose drops: This is an excellent remedy for symptomatic relief. The saltwater nose drops help in loosening mucus and clearing the airways.
• Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs are used to control fever. Common examples include paracetamol and ibuprofen.
• Steroids: Steroids work by decreasing swelling of the larynx due to their anti-inflammatory action. They can be given intravenously (IV), intramuscularly (IM), or orally (PO) depending upon the condition. Examples include:
  • Dexamethasone
  • Prednisolone
  • Budesonide
• Epinephrine (adrenaline): This drug is administered by nebulizer (through inhalation) to children. It works by dilating the muscles of the airway, increasing the supply of oxygen, which helps in managing symptoms. The effect of epinephrine is very immediate (usually within the first 30 minutes) of administration.
• Oxygen: Children with severe croup may need supplemental oxygen. It is administered through a mask or nasal cannula.
• Intubation: This involves the insertion of a tube into the trachea (windpipe) for respiratory support. It is used in children with life-threatening symptoms due to narrowing of the airway as a result of excessive swelling.
• Heliox: This is a mixture of oxygen and helium that is usually delivered to the individual through a nasal cannula and face mask. It is used if children are experiencing excessive difficulty in breathing. Helium aids in the movement of oxygen and decreases the load on respiratory muscles.
• Antibiotics: These are given in cases of bacterial croup. Vancomycin and cefotaxime are the two most common drugs used in cases of secondary bacterial infection.

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1. Inhale steam
   The use of inhaled hot steam or cool moist humidified air is proven to be beneficial for managing symptoms of croup. Caregivers should sit with the child during mist treatment. It is also important to keep the child calm, as anxiety and crying can worsen the symptoms. This can be achieved by engaging in activities such as reading a book, playing, and listening to music.
2. Encourage fluid intake
   Children should be encouraged to drink warm clear fluids. This helps in loosening mucus and keeps the child relaxed.
3. Minimize passive smoke
   Parents and caregivers of the infected child should avoid smoking, as it can worsen the child’s cough.
4. Keep the child's head elevated
   The head of the child should be kept elevated using extra pillows to prevent the accumulation of mucus in the throat. Note: Pillows should not be used with infants younger than 12 months of age.
5. Stay in close proximity to the child
   Parents and caregivers should stay close to the ill child to immediately assist in case of difficulty in breathing.
6. Keep the child calm
   Anxiety and crying may cause agitation, respiratory distress, and lead to increased oxygen requirements. Children should be kept as comfortable as possible.
7. Avoid self-medication
   Do not give medications for cold and cough without a prescription, as it can cause side effects.

Most cases of croup are mild and can be treated at home. Children with mild croupy cough just need parental guidance, reassurance, and proper care.

Most cases of croup resolve within a few days. The complications include:

• Bacterial tracheitis (infection of the trachea)
• Pneumonia
• Pulmonary edema (accumulation of fluids in the lungs)