Croup/Laryngotrakeobronchitis

Croup (laryngotrakeobronchitis) is a viral infection that causes inflammation and swelling in the upper respiratory tract (larynx, trachea and bronchi). Croup is characterized by dry cough and shortness of breath.

Cause. 

• Croup is usually caused by a para-influenza virus, respiratory syncytial virus (RSV) and influenza A and B viruses.
• The virus is commonly found in the air and is transmitted through sprinkling of saliva or through objects contaminated by the patient's saliva.
• Croup is most often found in children aged 6 months - 3 years.
• In severe cases, superinfection can occur by bacteria. This condition is called bacterial tracheitis and must be treated with antibiotics.
• If an infection occurs in the epiglottis, the entire air pipe can swell and can be fatal.

Symptoms. 

• Croup usually begins with flu-like symptoms.
• Swelling in the respiratory tract so that the airways narrow and sufferers experience respiratory problems. Respiratory problems, dry cough and hoarseness usually first appear at night.
• Respiratory problems cause the child to wake up from sleep. Breathing becomes rapid and deep, and half the sufferers experience fever.
• The child's condition will improve in the morning, but again worsen at night.
• Croup usually lasts for 3-4 days.
• Croup that recurs frequently is called spasmodic croup, which may be caused by an allergy, but is usually preceded by a viral infection.

Other symptoms that may be found :

• Stridor (high pitched breathing sounds).
• Cyanosis (skin color becomes bluish due to lack of oxygen).
• Intercostal retraction (increased use of neck and chest muscles in an attempt to breathe).

Diagnosis. 

• The diagnosis is made based on symptoms and physical examination results that show intercostal retraction when the child inhales.
• Examination with a stethoscope shows the presence of wheezing (wheezing breath), the inspiration phase (inhalation of air) and expiration (exhalation of air) which extends and decreases breathing sounds.
• Neck X-rays may indicate tracheal narrowing.

Treatment. 

• If the disease is mild, the child does not need to be hospitalized.
• At home you can use a humidifier to moisturize the air and children should drink plenty of fluids and get enough rest.
• If the disease is severe, usually the child is hospitalized and gets extra oxygen. To help breathing can be installed ventilator.
• Ultrasonic nebulizer can reduce the amount of mucus that reaches the lower respiratory tract and reduce the thickness of the mucus so that it is more easily removed through coughing.
• Bronchodilators (drugs to dilate the respiratory tract) can be inhaled through a nebulizer so that the child breathes more easily.
• As an initial treatment for severe croup, corticosteroids are given (but this is still controversial).
• If there is a bacterial infection, antibiotics are given.

Prevention. 

• To prevent shortness of breath, take the same steps that you use to prevent colds and flu. Washing hands frequently is the most important. Also keep your child away from people who are sick, and encourage your child to cough or sneeze into his elbows.
• To prevent more serious infections, keep your child immunized at this time. The diphtheria, Haemophilus influenzae type b (Hib) and measles vaccine provide protection from some of the rarest - but most dangerous - forms of upper respiratory tract infection.