Croup is an infection of the upper airway, which obstructs breathing and causes a characteristic barking cough.
MY son came back from kindergarten the other day feeling under the weather. He was sniffling and his eyes were red. We thought he had a cold and tucked him into bed.
The next day, he developed a loud cough, which sounded terrible, like an explosion. I was very frightened and took him to the paediatrician, who diagnosed him as having ‘croup’. I have never heard of this. What is it?
Croup is an infection of the upper airways, namely the larynx, trachea and bronchus. It usually happens in children between ages six months and three years, but it can occur at any age. However it is uncommon in adults.
Because these large upper airways are involved, breathing is obstructed in a certain way, and this causes the characteristic “barking” cough.
Why does the cough sound like that? I have never heard it before.
Croup can be caused by many things, namely:
> Virus (Most common infecting agent. Usually, it’s the parainfluenza virus, but it can also include the RSV, influenza, measles virus and adenovirus.)
> Acid reflux (Yes, this is also a cause!)
> Airway irritants like pollution, cigarette smoke and the haze
Once the infecting or inflaming agent is in, your child’s upper airways get inflamed. Naturally, the walls of his windpipe (trachea), vocal cords and bronchi become thickened and plugged with mucous. The passages through these are then narrowed.
The affected vocal cords result in the strange “barking” cough. Later, when your child takes a breath, these narrowed air passages can also produce a high-pitched whistling sound called stridor.
This sounds very scary. Is croup dangerous?
Croup is usually a mild disease caused by viruses and can be treated at home.
But once upon a time, before vaccines were available, croup was a deadly disease, mainly because of the diphtheria bacteria. Children used to die from it.
Today, it still can be dangerous if there is a bacterial infection on top of the viral infection. If a part of your child’s trachea called the epiglottis (which prevents food from entering the airways) is infected, then the entire windpipe can swell and totally obstruct breathing.
This is potentially fatal if treatment is not sought immediately.
In all cases of suspected croup, please seek a paediatrician.
So croup is only characterised by this barking cough and stridor?
There are other associated symptoms. Look out for:
> The barking, seal-like cough
> Stridor when inhaling and exhaling
> Drooling or difficulty swallowing, especially for toddlers
> Anxious, agitated and tired
> Breathes at a faster rate than normal
> Has difficulty breathing
> Becomes blue around the mouth, nose or fingernails (cyanosis, a sign of low oxygen).
If your child can tell you he is having these difficulties, then there is less of a problem. But when croup develops in infants and toddlers, they often can’t tell you these things. So you have to be very mindful.
Most children have a cold or flu for several days before the barking cough starts.
Croup is worst at night and usually lasts for five to six nights. Very rarely does it last for weeks. The first two nights are usually the worst.
What shall I do about my son’s croup?
Take him to a paediatrician. I prefer to take children to paediatricians for childhood diseases because paediatricians specialise in diseases like this, and can recognise a lot of symptoms and signs in your child that a normal GP may not.
This is especially important if your child is an infant or toddler. Children tend to present with very non-specific symptoms and signs like irritability, refusal to feed or agitation. Unless your GP is trained to recognise these, it is usually safer to go to a child specialist.
The doctor will examine your child. If the causing pathogen is a virus, there is nothing we can do except offer symptomatic relief – such as paracetamol to bring down a fever, and steroid aerosols to relieve the cough and stridor.
Try not to give your child cough suppressants.
Breathing moist air will relieve your child’s breathing. So you can put a humidifier in his room.
Serious croup and the breathing difficulties that come with it require hospitalisation.
Viral croup usually lasts for three to seven days.
Dr YLM graduated as a medical doctor and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail email@example.com. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.