Croup, also known as viral laryngotracheitis, is a common respiratory illness in young children. It is most commonly caused by parainfluenza virus but can be caused by rhinovirus, respiratory syncytial virus, and adenovirus. It is mostly in children who are less than 6 years of age and occurs usually in the fall or winter months. It is spread through contact droplets that go into the air when a person coughs or sneezes.
Clinical Symptoms
Symptoms of croup include nasal discharge and congestion that progress to fever, hoarseness, barking cough, and stridor, which is noisy, high-pitched breathing. Respiratory distress can occur if airway obstruction worsens and can present with signs of cyanosis, pallor, and mental status changes. Caregivers should seek immediate help if the child’s breathing becomes labored, they show signs of cyanosis, difficulty swallowing, inability to cry or speak, severe agitation, and stridor.
Diagnosis
Diagnosis of croup can be done clinically usually with the presentation of stridor and a barking cough. A chest x-ray can be performed to see subglottic narrowing, also called the steeple sign. Acute epiglottis, peritonsillar and retropharyngeal abscesses, anaphylaxis, and foreign body aspiration should all be ruled out as well. Recurrent episodes of croup-like symptoms that are atypical or that occur outside of the typical age range should raise suspicion for other conditions like congenital airway abnormality, gastroesophageal reflux, or eosinophilic esophagitis.
Treatment and Prevention
Management of croup can usually be decided usually the Westley croup severity score which includes: level of consciousness, cyanosis, stridor, air entry, and retractions. The minimum score is 0 and the maximum is 15. A mild score that is less than 2 can be managed with outpatient therapy using oral dexamethasone or oral prednisone. A moderate score between 3 and 7 can be managed with nebulized epinephrine and oral dexamethasone. A severe score between 8 and 11 can be managed with a single dose of oral or IV dexamethasone and repeated doses of nebulized epinephrine. A score that is 12 or higher indicates impending respiratory failure and usually requires intensive care unit admission and intubation. Supportive care includes antipyretics, fluids, and oxygen or humidified air as needed. Oral hydration is preferred to IV because it is less invasive and decreases the risk of infection. Mist therapy can provide a sense of comfort to the child along with oxygen therapy if the oxygen level is too low. Patients should have their oxygen levels, breathing, heart rate, and level of alertness monitored. Symptoms typically resolve within two days but teh cough can persist for up to one week.
Croup can be very serious but there are some ways to lower the risk. These include washing your hands and your child’s hands using soap and water or an alcohol-based hand rub and staying away from adults and children who are sick. Although there is no vaccine against the parainfluenza virus, children should be vaccinated against other causes of croup, including influenza and COVID-19.
References
Wood, C., & Kaplan, S. L. (2024). Croup: Management. UpToDate.
https://www.uptodate.com/contents/croup-management?search=croup&source=search_result&s lectedTitle=2%7E67&usage_type=default&display_rank=2 Assessed and Endorsed by the Medreport Medical Review Board