Croup is a common respiratory infection primarily affecting young children, typically between six months and three years of age. This condition leads to swelling within the upper airways, specifically around the voice box (larynx) and windpipe (trachea). The characteristic symptom of croup is a distinctive “barking seal” cough, often accompanied by a hoarse voice and noisy breathing.
Understanding Croup Severity
Most instances of croup are mild and resolve without severe complications, with symptoms typically improving within a few days. However, a small percentage of cases, less than 1%, can progress to severe forms, necessitating medical attention. The primary concern in severe croup is significant swelling in the airway, which can obstruct breathing and lead to respiratory distress. While fatalities from croup are extremely rare, severe airway compromise is a serious concern.
Croup is most frequently caused by viral infections, such as the parainfluenza virus. Historically, epiglottitis, a more dangerous bacterial infection causing severe airway swelling, was a significant concern and could be confused with croup. However, widespread vaccination against Haemophilus influenzae type b (Hib) has made epiglottitis very uncommon today.
Recognizing Emergency Signs
Parents should recognize specific symptoms indicating a medical emergency. One such sign is stridor at rest, a high-pitched, harsh sound heard when a child inhales, even when calm or sleeping. Difficulty breathing, characterized by rapid breathing, flaring nostrils, or chest retractions (where the skin visibly pulls in around the ribs or neck with each breath), also requires urgent care.
Bluish discoloration around the mouth or fingernails (cyanosis) indicates insufficient oxygen in the blood. Excessive drooling or difficulty swallowing can also be a warning, suggesting a more serious upper airway condition like epiglottitis. A child who becomes unusually agitated, restless, or lethargic, or has a high fever unresponsive to medication, also needs prompt medical attention.
Medical Care for Severe Croup
When a child presents with severe croup, medical intervention focuses on reducing airway swelling and supporting breathing. In a hospital setting, common treatments include administering humidified oxygen to ease respiratory effort. Nebulized epinephrine, delivered through a mask, is often used to quickly reduce inflammation in the airway. This medication helps to constrict blood vessels, thereby decreasing swelling.
Corticosteroids, such as dexamethasone, are also given to reduce inflammation and swelling over a longer period. These medications typically begin to show effects within a few hours and can significantly improve symptoms. While rare, in extremely severe cases where airway obstruction is life-threatening and other treatments are insufficient, a breathing tube may be temporarily placed into the windpipe (intubation) to secure the airway. Close monitoring of the child’s breathing and oxygen levels is important for prompt response to any changes.