Croup is a common respiratory disease among children, due to lack of awareness, increased interaction with others, and an incomplete immune system. Croup is characterized by a barking cough, shortness of breath, and a crackling sound during breathing. In this article, Dalili Medical, we will review croup, explaining its symptoms, causes, methods of diagnosis and treatment.

Who is most susceptible to croup?

 

Croup appears especially in children between the ages of 6 months and 3 years. This disease is more prevalent in the fall, winter and spring seasons. The infection is known as an infection that affects the lower respiratory tract and is caused by viruses and bacteria. It is noted that croup is more common among boys than girls.

What is the difference between false croup and true croup?

 

A distinction is made between "false croup" and "true croup", as "true croup" is actually a bacterial (germ) infection. On the other hand, the term “pseudocroup” refers to swelling of the mucous membrane in the upper airway (larynx). Medical practitioners use the term subglottic laryngitis to refer to pseudocroup, which means it is an infection of the larynx below the vocal cords.

Is croup serious?

 

Children with croup usually have mild symptoms, but they can sometimes get worse. Most recover quickly, with symptoms such as a cough and a runny nose. Mild breathing difficulties may occur, and these symptoms usually last a night or two, which can be difficult for parents.

In severe cases, the airway can become so narrow that hospital admission is required.

Children often improve quickly in hospital, and are usually discharged within 24 hours.

In some cases, temporary ventilator support may be needed until the inflammation resolves.

About one in ten children with croup need to be monitored in hospital.

Can the condition resolve on its own without medication?

 

Croup is caused by a virus and usually starts suddenly in the middle of the night. It may be accompanied by a runny nose and fever, followed by coughing fits. This is due to irritation of the upper airways and throat, leading to inflammation. In most cases, symptoms are mild, and croup can resolve without the need for medication. However, if the condition worsens and the airway continues to deteriorate, further evaluation and treatment may be necessary. Signs that croup is worsening include: a loud whistling sound when inhaling, difficulty breathing, and use of the muscles in the neck and chest (retraction). If your child does not improve after 30 minutes, it is important to seek medical evaluation.

Why is croup rare in adults?

 

This is because adults have wider and larger airways, which means that the swelling does not cause the characteristic symptoms of croup such as a severe cough and wheezing. Instead, the symptoms of the disease appear similar to any normal viral infection, such as a cold or laryngitis, except in severe cases. In contrast, children's airways are smaller, so the swelling caused by the croup virus causes them to narrow severely and cause a loud cough. Croup is most common in children aged two years and older, but it can occur in any age group.

How long does croup last?

 

Croup usually lasts for a few days, and is often worse at night. Symptoms can be heard during the day, but they are most noticeable at night, especially between 11:00 p.m. and 1:00 a.m. Symptoms can range from mild to severe, but the worst symptoms usually appear in children under the age of three, and are usually not noticed until the age of eight when the child's airway is larger, allowing more swelling to be tolerated before the airway becomes too narrow.

**Is croup contagious?**

 

Yes, croup is contagious, caused by viruses similar to those that cause the common cold. It mainly affects children under the age of 6.

**Does asthma make it worse?**

 

Asthma is a condition that affects the lower airways (respiratory tract) and causes wheezing, coughing, and difficulty breathing. Although it is a completely different condition from croup, having asthma (or another lung condition) at the same time as croup can make breathing difficult.

**Is croup dangerous for adults?**

 

Yes, croup is a serious condition in adults because of the severe swelling of the windpipe and larynx. Those affected often need to be treated in an intensive care unit. Typically, when adults get a viral illness, they may have no noticeable symptoms or only mild to moderate symptoms similar to a cold. But in severe cases, croup can cause significant swelling and narrowing of the trachea, leading to difficulty breathing and severe oxygen deficiency.

What are the causes of croup?

 

Croup is usually the result of a viral infection, as viruses, infections, and bacteria are common causes of this disease. Discomfort usually develops as a result of a viral infection, which increases the risk of transmission. The virus enters the body by inhaling contaminated droplets, and not touching things that may contain the virus, and then avoiding putting your hands on your mouth, nose, or eyes, helps reduce the chances of infection.

- Croup is often caused by a viral infection, especially the parainfluenza virus.

- The disease usually spreads in winter and early spring, and poses a great risk to the lives of premature babies and children with narrowed airways.

- Sometimes, croup can occur as a result of a bacterial infection, as these children suffer from a high temperature and difficulty breathing. Spasmodic croupIt is a type of croup that recurs several times without being accompanied by a high temperature or infection, and the barking cough begins suddenly, often at night, and is often associated with a tendency to allergies.

- Croup is caused by a viral infection.

**Symptoms of pseudocroup**

Pseudocroup usually begins with colds and rhinitis with a slight rise in temperature. Symptoms usually appear a few days after infection, and often occur in the evening or night.

Common symptoms of pseudocroup include:

- A barking cough.

- A rough or screaming sound when breathing.

- Hoarseness.

Shortness of breath is another common symptom, as swelling narrows the larynx, causing children to breathe faster and deeper. While most children experience mild shortness of breath, this feeling often causes them to be frightened, prompting them to cry, which may increase the severity of their shortness of breath.

**Causes of Pseudocroup**

Specific cold viruses are usually responsible for pseudocroup. Although parainfluenza viruses typically cause coughing, rhinitis, and hoarseness, in some cases, inflammation of the lining of the throat can occur, causing it to swell.

**How ​​common is pseudocroup**

 

Pseudocroup is most common in the fall and winter, and children between the ages of 6 months and 3 years are most likely to develop the condition. About 3 out of every 100 children in this age group develop pseudocroup each year, while adults rarely develop it.

**How ​​does pseudocroup develop?**

A child usually starts with a cold and rhinitis with a slight fever. After a few days, pseudocroup symptoms may appear suddenly, often at night. Most children have mild symptoms that go away on their own within a couple of days.

**Symptoms of croup**

Symptoms vary depending on the severity of the condition.

. **General symptoms of croup**

Clinical symptoms of croup include:

- Runny nose.

- Mucus discharge.

- Slight fever.

- Severe cough, especially at night and when crying.

. **Symptoms of acute croup**

Symptoms appear when you have acute croup, including:

- Hoarseness.

- Strong barking cough similar to the sound of a wolf.

- Stridor that initially appears only when exerting effort or crying, but may also occur during quiet breathing in more severe cases.

- Shortness of breath.

- Excessive use of the respiratory muscles with a hollow in the chest with each inhalation.

- Cyanosis.

- Pallor around the mouth accompanied by restlessness, which increases the severity of the stridor.

- General fatigue.

- Coma.

Symptoms of croup peak two to three days after the onset of infection, and usually last less than a week.

When should you seek medical help for croup syndrome?

 

You should consult your pediatrician in the following cases:

- Worsening of breathing symptoms, such as:

- Increased breathing rate

- There is a clear effort during breathing, with a contraction of the chest or neck muscles

- The child feels anxious or agitated

- Unusual paleness in the child's skin color

- High temperature

- The child turns blue (cyanosis)

- Excessive sleepiness

- Severe difficulty breathing

- Inability to swallow and increased drooling

**Diagnosis**

This disease is diagnosed by evaluating the symptoms and clinical examination of the pharynx and larynx, in addition to performing some necessary blood tests, including:

- **CBC blood test**: This test is used to determine the type of disease and differentiate between false croup and true croup. In pseudocroup, the white blood cell count increases with a decrease in lymphocytes due to viral infection, while in true croup, the white blood cell count increases with an increase in neutrophils due to bacterial infection.

- **CRP analysis**: An increase in this protein indicates inflammation in the body, which helps in diagnosis and assessing the effectiveness of treatment.

A warning sign that the condition is worsening is a noticeable collapse of the skin between the ribs when the child breathes. Sometimes the child may suffer from severe shortness of breath, which leads to his face turning blue or feeling very tired.

These problems can be caused, for example, by inflammation and narrowing of the airways, or may be due to purulent inflammation of the epiglottis, in which case it may be necessary to perform a laryngoscopy to determine the exact cause.

**Treatment of croup in adults**

Croup is treated in the hospital or in the intensive care unit, where treatment aims to stabilize the patient's condition, relieve symptoms, and facilitate the breathing process. Possible treatments depending on the severity of the condition include:

- **Oxygen**: This is used in cases of severe difficulty breathing and lack of oxygen in the lungs. Oxygen can be given either through a mask or a nasal tube, and in critical cases, a ventilator may be required.

- **Epinephrine**: This is given through a spray or vaporizer, and helps quickly reduce swelling and inflammation in the trachea, making it easier for oxygen to reach and help breathing. However, its effect is temporary and may require use several times.

- **Cortisone**: Such as dexamethasone or prednisone, which also helps reduce inflammation and swelling in the trachea. Cortisone takes several hours to take effect, but it lasts longer. It can be given either intravenously or orally depending on the severity of the condition.

**Dexamethasone**: This is often used to reduce inflammation and reduce the severity of symptoms.

**Inhaled adrenaline (epinephrine)**: This is given in hospitals for moderate to severe cases with the aim of reducing swelling of the trachea and improving breathing.

**Home remedies to treat croup in children**

 

Here are some effective home remedies to relieve the symptoms of croup.Q in children.

. **Steam inhalation** Steam inhalation is one of the best home remedies to relieve symptoms associated with croup. The warm steam from a hot shower helps relieve congestion and makes breathing easier. The heat and humidity also promote the fluidity of mucus, making it easier to expel.

Despite the benefits of steam inhalation, it should be done with caution and under adult supervision.

Therefore, it is preferable to avoid the traditional method of using a bowl of hot water, as it requires inhaling the steam by covering the face with a towel. Instead, you can opt for a steam shower.

Turn on the hot shower and close the door to prevent the steam from escaping. Sit with your child in the steamy bathroom (avoid leaving the child alone).

Allow your child to inhale the steam for at least 30 minutes, and repeat the process as needed.

**. Increase air humidity** Moist air contributes to easier breathing, so it is important to increase the humidity level in your home, especially in your child’s bedroom.

Humidity also helps to relieve nasal congestion and reduce coughing.

Low temperatures and humidity are often associated with an increased risk of respiratory infections, which means that unfavorable conditions can precede these infections.

So, it is best to use a humidifier in your home, especially in the room where your child sleeps.

Another alternative is to place a bowl of hot water in the room to increase the humidity of the air, or you can place a pot of water on the heater in your child’s room.

Whether you choose to use a humidifier or a bowl of hot water, make sure to place it in a safe place to avoid any accidents.

**Preventing dehydration** When your child is suffering from croup, it is essential that you do your best to keep them hydrated, which helps reduce breathing problems.

Maintaining a good level of fluids is very important, as lack of fluids can lead to increased thickness of the mucus caused by croup, which can be caused by viruses or colds and flu.

Experts believe that croup can be effectively managed by encouraging your child to drink enough fluids.

If your child refuses to drink large amounts of fluid at once, you can offer small amounts more frequently.

For infants, breast milk or formula is a good option. Electrolyte replacements can also be given if your doctor recommends it.

For older children, water, along with soups or frozen fruit, can be very helpful. Bone broth or a light soup made from bone broth is also a good option.

Apple juice, lemon juice, or herbal tea provide hydration with the added benefit of boosting immunity and fighting infection.

**Essential Oil Massage** Gently massaging the chest area with a blend of essential oils can help relieve muscle tension and promote relaxation, making it easier for your child to breathe.

To make the oil, mix 10 drops of eucalyptus essential oil with ½ cup of warm extra-virgin olive oil. Use this mixture to gently massage your child’s chest, preferably before bedtime to help them sleep better.

Another option is to mix 10 to 15 drops of oregano oil with 2 tablespoons of jojoba oil. This mixture can be used as a chest rub before bed to relieve nighttime coughs.

If you don’t have essential oils, you can use Vicks as an alternative. However, if your child is two years old or younger, it’s best to consult a doctor before using Vicks.

In a 2010 study published in Pediatrics, researchers compared the use of Vicks VapoRub to another treatment to relieve nighttime cough symptoms in children, and found that Vicks VapoRub had a significant positive effect in reducing symptoms of upper respiratory infections.

**Upright Position** Keeping your child upright can help make breathing easier and significantly reduce congestion. On the other hand, lying down can trigger coughing fits, which can make the condition worse. A 2002 study published in the Australian Journal of Physiotherapy suggests that to enhance the power of expiratory maneuvers, patients are advised to adopt a more upright position while coughing or exhaling.

You can hold your child on your lap or place them in a chair to help ease breathing difficulties and coughing.

**Sponge Bath** If your child has a fever, a sponge bath can be an effective way to relieve it.

A cool sponge bath helps regulate your child’s body temperature and provides quick relief from fever by temporarily reducing the temperature. It also helps your child relax and helps him sleep better.

A study published in 2013 in the Journal of Family Medicine and Primary Care suggests that using cool sponges is safe and recommended as a way to reduce fever in children.

To sponge bath, soak a washcloth in cool or room temperature tap water, then wring it out and start scrubbing your child’s armpits, feet, hands and thighs. You can repeat the sponge bath 2 or 3 times a day.

You can also place a damp, wet washcloth on your child’s forehead and change it every few minutes to help lower the temperature.

For older children, a cool bath or shower can be a great way to help.

**Honey** If your child is over a year old, honey is an effective remedy for many ailments.

With its antibacterial and antioxidant properties, in addition to boosting immunity, honey helps fight bacterial and viral infections, and can relieve symptoms of croup.

In a 2012 study published in the journal Pediatrics, parents showed a preference for honey products over gonorrhea extract in relieving symptoms of nighttime cough and difficulty sleeping.

You can add a teaspoon of raw honey to a cup of warm water or milk, and then give it to your child 2 or 3 times daily.

Another option is to mix 2 teaspoons of raw honeyM with a teaspoon of lemon juice, and give it to your child 2 or 3 times a day.

**Rest** Bodies heal and repair themselves during sleep, so it is important for your child to get enough rest and sleep when they suffer from croup.

A study conducted in 2015 indicates that sleeping after an injury contributes to improving the body's structure.

However, you should avoid sleeping the child in a flat position, as the elevated position facilitates the breathing process and reduces the possibility of coughing.

It is also preferable not to allow your child to play outside the house or run, as this may increase the cough.

At the same time, it is important to create a calm environment, as any kind of stress can exacerbate breathing difficulties. You can help your child feel calm and distracted by reading books or playing fun games, which also promotes the healing process faster.