Croup, or laryngotracheobronchitis, is a viral infection that causes the larynx or trachea (the upper part of the windpipe, near the vocal cords) to narrow due to swelling. The larynx goes into spasms, and the sufferer experiences difficulty breathing; a harsh-barking cough; hoarseness; tightness in the lungs; and feelings of suffocation. Mucus production may also increase, further clogging the airway.
In the beginning, croup has all the hallmarks of the common cold. It starts off with congestion, a stuffy or runny nose for a few days and may have a fever (over 101°F). The upper airway (the lining of the trachea and larynx) becomes progressively inflamed and swollen. Croup is a respiratory infection that causes the larynx (voicebox) or trachea (windpipe) to narrow due to swelling. The larynx goes into spasms, and the sufferer experiences difficulty breathing; a harsh, loud, barking cough (resembles the barking of a seal); hoarseness; tightness in the lungs; and feelings of suffocation, especially when a child is crying or upset. Mucus production may also increase, further clogging the airway. If the upper airway becomes swollen to the point where it is partially blocked off, it becomes even more difficult for a child to breathe. This happens with severe croup. One of the trademarks of severe croup is a harsh, high-pitched wheezing noise or squeaking noise (called stridor) that is made when air is breathed in through the constricted windpipe and over inflamed vocal cords. Fits of coughing is another characteristic symptom. A child will tend to breath very fast, and the stomach or the skin between the child's ribs may seem to pull in during breathing. The child may also appear pale or bluish around the mouth because he or she is not getting enough oxygen. In addition to the effects on the upper airway, the infections that cause croup can result in inflammation further down the airway, including the bronchi (breathing tubes) and the lungs.
FREQUENCY OF OCCURRENCE
Croup most commonly occurs in young children and babies between ages 3 months and 5 years (1 to 3 years most frequently), whose airways are much narrower than those of adults. About 275,000 children under the age of 6 get croup each year in the United States.
Attacks occur frequently at night and croup usually lasts 5 to 6 days in duration (peaking 2 to 3 days after the symptoms of infection start). Incubation period (the time between infection and the onset of symptoms) depends on the virus causing the croup. For parainfluenza virus, it is usually 3 to 5 days. In the past, this illness was often caused by the measles virus, but not that many children are immunized against measles, croup has become much less common than it once was. Croup resulting from viral infection usually lasts less than a week. The virus usually runs its course in 5 to 6 days. Croup is most likely to occur in outbreaks during the winter months and early spring when viruses that usually cause it peak, and symptoms are most severe in children younger than 3 years of age. Many children who come in contact with the viruses that cause croup will not get croup, but will instead have symptoms of a head cold. Most croup due to viruses is mild and can be treated at home, though rarely viral croup can be severe and even life-threatening. Some children are more prone to developing croup, especially those who were born prematurely or who were born with narrowed upper airways.
Spasmodic croup is a term used to refer to a condition similar to viral croup, except that there are no accompanying symptoms of an infection. The cough frequently begins at night with a sudden onset. The child usually has no fever with spasmodic croup.
The majority of children recover from croup with no complications. Rarely, some children will develop complications such as ear infection or pneumonia. Children who have a history of lung disease (such as asthma) are more likely to develop more severe symptoms of croup and may require hospitalization. Croup very rarely causes any long-term complications.
Prevention is better than solving a problem. Frequent hand washing and avoiding contact with people who have respiratory infections are the best ways to reduce the chance of spreading the viruses that cause croup.
Croup is usually proceeded by a cold, bronchitis, or an allergy attack, but can also occur if a foreign body is inhaled. Most croup is caused by viruses, but similar symptoms may occasionally be caused by bacteria or an allergic reaction. The viruses most commonly involved are parainfluenza virus (accounting for most cases), adenovirus, respiratory syncytial virus, influenza, and measles.
Croup is most often caused by parainfluenza virus, primarily types 1 and 2, but other viral and possibly bacterial infections can also cause it. It is most common in the fall and winter but can occur year-round, with a slight predilection for males.
The respiratory distress is caused by the inflammatory response to the infection, rather than by the infection itself. It usually occurs in young children as their airways are smaller and differently shaped than adults', making them more susceptible. There is some element of genetic predisposition as children in some families are more susceptible than others.
An entity known as spasmodic croup also occurs, distinct from the infectious variety, due to laryngeal spasms.
DIAGNOSIS & TREATMENT
Health care providers (and parents) can usually diagnose croup by looking for the telltale barking cough and stridor, the high-pitched squeaking sound on inhaling. Stridor will be provoked or worsened by agitation or crying. If stridor is also heard when the child is calm, critical narrowing of the airway may be imminent. They will also check the child for fever, cold symptoms (like a runny nose), nausea/vomiting or a recent viral illness, and ask questions to find out if the child has a prior history of croup or upper airway problems. Hoarseness is usually present. More severe cases will have respiratory distress.
If the child's croup is severe and slow to respond to treatment, a neck X-ray may also be taken to rule out any other reasons for the breathing difficulty, such as a foreign object lodged in the throat or epiglottitis (an inflammation of the epiglottis, the flap of tissue that covers the windpipe). Typical findings on a frontal X-ray of the cervical spine, if a child has croup, includes the top of the airway narrowing to a point, which health care providers call a steeple sign.
MEDICAL DIAGNOSIS OF CROUP
Croup is a group of respiratory diseases that often affects infants and children under age 6. It is characterized by a barking cough; a whistling, obstructive sound (stridor) as the child breathes in; and hoarseness due to obstruction in the region of the larynx. It may be mild, moderate or severe, and severe cases, with breathing difficulty, can be fatal if not treated in a hospital.
Croup affects 5% of children in the second year of life; the peak incidence is between 7 and 36 months. The group of respiratory diseases consists of spasmotic croup, acute laryngotracheitis, laryngotracheobronchitis (LTB), laryngotracheobronchopneumitis (LTBP), and laryngeal diptheria. LTB and LTBP, which usually involve a bacterial infection, are usually severe.
The first step in diagnosis is to exclude other acute obstructive illnesses in the region of the larynx, such as epiglottitis, a foreign body, or angioneurotic edema of the epiglottis. Misdiagnosing an obstructive airway disease can be fatal.
The Alberta Clinical Practice Guideline Working Group has developed guidelines for diagnosing and treating croup, including a scoring system for classifying severity. The severe form (which affected less than 1% of children seen in the emergency department) involves breathing difficulties, indicated by stridor, chest retractions, agitation and distress. Lethargy or decreased level of consciousness is a sign of impending respiratory failure, and requires emergency medical treatment. LTB and LTBP are usually severe, and require treatment in the intensive care unit, with a throat tube to assist breathing, and antibiotics.
Since laryngotracheitis is a viral disease (most commonly parainfluenza virus 1) antibiotics have no value. Croup can be prevented by immunization for influenza and diphtheria. At one time, croup is referred to a diphtherial disease, but with vaccination diphtheria is rare.
Most, though not all, cases of viral croup are mild. Breathing in moist air seems to relieve many of the symptoms. Conventional health care providers will also sometimes treat with steroids, which helps with the airway swelling.
One way to humidify the air is with a cool-mist humidifier. Having your child breathe in the moist air through the mouth will sometimes break a croup attack. Or try running a hot shower to create a steam-filled bathroom where you can sit with your child for 10 minutes. Try cuddling and reading a bedtime story while doing this to help calm your child.
Sometimes, during cooler months, taking your child outside for a few minutes can help break the attack because the cool air can shrink the swollen tissues lining the airway. Parents can also try driving the child in the car with the windows down to bring in cool air. Be careful about allowing the child to become "chilled" while treating him or her with cool outdoor air.
If your child has croup, consider sleeping overnight in the same room to provide close observation. If you are not able to break your child's fast breathing and croupy cough, call your child's health care provider or seek medical attention as soon as possible.
Cough medicines are generally not recommended. However, if the child's health care provider recommends it, Robitussin DM can be used to lessen your child's coughing. Robitussin Pediatric has one-half the dextromethoraphan (cough suppressant) as Adult Robitussin in one teaspoon. The dose of Adult Robitussin is 1/4 to 1/2 teaspoon for each 10 pounds of body weight or for Pediatric Robitussin, the dose is 1/2 to 1 teaspoon for each 10 pounds of body weight. Or example, If your child is 20 pounds, he/she can have 1/2 to 1 teaspoon of the Adult Robitussin. This dose can be repeated every 4-6 hours as needed for relief of the cough. The maximum single dose of Adult Robitussin is 2 teaspoons or 4 teaspoons of Pediatric Robitussin. Always consult your health care provider before using a cough remedy and make sure you have the appropriate doses for your child.
FEVER AND PAIN MEDICATIONS
If your child has a fever (over 101°F) you may give acetaminophen (Tylenol). You may give your child acetaminophen (Children's Tylenol, Infant's Tylenol) for is or her chest discomfort or discomfort due to fever.
PRESCRIPTION MEDICATIONS & TREATMENT
Medical professionals will need to evaluate your child if the croup appears serious or if there's any suspicion of airway blockage or bacterial infection. Medications such as epinephrine or corticosteroids may be given to reduce swelling in the upper airways. Oxygen may also be given, and sometimes a child with croup will remain in the hospital overnight for observation. As with most illnesses, rest and plenty of fluids are recommended.
Mild croup with no stridor, or stridor only on agitation, and just a cough may simply be observed, or a dose of inhaled, oral, or injected steroids may be given. When steroids are given, dexamethasone is often used, due to its prolonged physiologic effects.
The routinely recommended treatment is with corticosteroids, although corticosteroids suppress the immune system and can predispose the child towards infection. There is a debate over how many doses to give, but an article in the New England Journal of Medicine recommends one dose, and has observed that children with viral, bacterial and fungal complications have had multiple doses.
Moderate to severe croup may require nebulized adrenaline in addition to steroids. Epinephrine produces a significant reduction in the croup severity score but the benefit only lasts for 2 hours. Oxygen may be needed if hypoxia develops (blood oxygen saturation under 92%). Children with moderate or severe croup are typically hospitalized for observation, usually for less than a day. Intubation is rarely needed (less than 1% of hospitalized patients).
Viral croup is a self-limited disease, but can very rarely result in death from complete airway obstruction. Symptoms may last up to 7 days, but typically peak around the second day of illness. Rarely, croup can be complicated by (or confused with) an acute bacterial tracheitis, which is more dangerous.
HERBAL & HOLISTIC RECOMMENDATIONS
The following herbs and herbal treatments are recommended for croup:
Echinacea, Fenugreek, Goldenseal, and Thyme. Echinacea tincture should be taken if a fever is present. Take 15 drops in liquid every 3 to 4 hours. Caution: Do not take goldenseal on a daily basis for more than a week at a time, and do not use it during pregnancy. If you have a history of cardiovascular disease, diabetes, or glaucoma, use it only under a health care provider's supervision.
Put a few drops of Eucalyptus Oil in a vaporizer and inhale the steam.
Give a child with croup very warm ginger herb baths; then immediately wrap the child in a heavy towel or blanket, and put him or her to bed to perspire. This helps loosen the mucus and rid the body of waste.
Fenu-Thyme Combination from Nature's Way Products is good for congestion.
Most children with mild croup can be treated at home. You should make your child as comfortable as possible.
Smoking will make croup worse. Do not let anyone smoke around your child at any time.
Give a child with croup plenty of liquids to help thin and loosen up the mucus. Use clear fluids (ones you can see through). Warm fluids may help to relax the vocal cords and also loosen up the mucus. Steam-distilled or quality bottled water, herbal teas, apple juice, lemonade and homemade soups, such as chicken or vegetable broth are good choices.
Make sure the child gets plenty of rest.
Apply hot onion packs over the chest and back three times a day. Slice onions and place them between cloths, and then apply the pack and cover it with a heating pad. Onion packs open the pores and relieve congestion.
If your child has a mild attack of stridor, try having him or her breathe moist air. This is called mist treatment. You can give your child a mist treatment at home in a variety of ways:
1. Have your child breathe through a warm, wet washcloth placed over the nose and mouth.
2. Run hot water in your shower with the bathroom door closed. Once the room has become steamy or has fogged up, sit with your child in the room for about 10 minutes. You can cuddle your child and read a bedtime story to help calm him.
3. Sometimes it helps to take your child outdoors during the cooler months for 10 minutes or for a drive in the car with the windows down to bring in cool air. Be sure to dress appropriately for the weather. The fresh air can help with breathing difficulties by shrinking the swollen tissues lining the airway. (Note: This treatment is also helpful for an asthma attack too. The cool air helps to open up passageways. However, cold weather (below freezing) is not recommended for breathing problems since it can actually irritate the respiratory system and cause increased breathing difficulty. If you have problems with asthma or other respiratory difficulties, be sure to cover your nose and mouth with a scarf or face mask of some type and breath through your nose, which helps to warm the air before it reaches the lungs, while outdoors in cold weather to prevent problems.)
4. You can purchase a water vaporizer at most drug stores that can help put moisture back in the air. Some use cool water (cool-mist humidifier) and some are steamer vaporizers that produce a steam vapor. Ask your health care provider which would work best for your particular situation. Some children will respond better to one than the other.
If your child has croup, consider sleeping overnight in the same room as him or her to be able to provide close observation. It may be helpful to prop the child up, using pillows, into a semi-reclining position to help breathing. Laying flat on the back often makes breathing more difficult. If you are not able to break your child's fast breathing and croupy cough, call your child's health care provider.
If a child with croup is having difficulty breathing, take him or her to the emergency room of the nearest medical facility for treatment and for X-rays of the larynx to rule out any other reasons for the breathing difficulty, such as a foreign object lodged in the throat or epiglottitis (an inflammation of the epiglottis, the flap of tissue that covers the windpipe). Typical findings on an X-ray if a child has croup includes the top of the airway narrowing to a point, which health care providers call a steeple sign. Antibiotics (for bacterial infections) and oxygen may be needed. Medications such as epinephrine or corticosteriods may be given, and sometimes a child with croup will remain in the facility overnight for observation.
Milder cases of croup can be treated at home, but parents should be alert for signs of increasing difficulty.
If antibiotics are prescribed, use some form of acidophilus.
Unless otherwise specified, the following recommended doses are for adults over the age of 18. For a child between 12 and 17 years, reduce the dose to 3/4 the recommended dose. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended dose.
NUTRIENTS Supplement Suggested Dosage Comments Essential Vitamin C With Bioflavonoids 60 mg 4 times daily for children 6-12 months old;
100 mg 4 times daily for ages 1-4 years old.
500 mg 4 times daily for children over 4.
Helps control infection and fever by boosting the immune system.
Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz., Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs, Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps, The Right C, Nature's Way, 1000 mg, 120 Tabs
Zinc 5 mg once daily for 3 days for children 6-12 months old.
5 mg twice daily for 3 days for ages 1-3 years old.
5 mg 3 times daily for 3 days for children over 3 years old.
Promotes immune function and is necessary in healing. Use lozenges for faster absorption.
Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.,
Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges,
Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges,
Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps
Very Important Vitamin A
2,000 IU daily. Needed for healing of the mucous membranes, Use an emulsion form.
Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 Softgels
Vitamin E 10 IU daily for children under age 3.
20 mg daily for ages 3-6.
50 mg daily for children age 6-8.
100 IU for children 9-13 years old.
Destroys free radicals and carries oxygen to all cells. Use emulsion forms for easier assimilation. If using softgels, break open the softgel and place a drop of vitamin E on the child's tongue.
Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels,
Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels,
Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels,
Vitamin E, d-alpha-tocopherol, 400 IU, 100 Softgels
Important Acidophilus As directed on label. Take on an empty stomach. Take separately from any antibiotics given. Replenishes essential bacteria if antibiotics are used.
Lactobacillus Acidophilus, Kosher Liquid, All Natural, Vegetarian Medium, Lactose Free, Apple Strawberry Flavor, Dynamic Health, 16 fl. oz.,
Acidophilus Supplement Powder, Non Dairy, 3 oz. Bulk
Cod Liver Oil 1 Tablespoon twice daily in juice. Can be used for children in place of vitamin A.
Cod Liver Oil, Great Tasting Strawberry Flavor, ChildLife, 8 fl. oz.,
Barlean's Fishery Cod Liver Oil, Fresh Catch, Lemonade Flavor, 8 fl. oz.
CROUP SUPPLEMENTS & PRODUCTS
Supplements and products for Croup, a viral infection that causes the upper part of the windpipe (larynx) to swell.
Aromatherapy Burner Igloo Design
By varying the oils and combinations, you will be able to change the atmosphere in your surroundings with this attractive incense burner.
Aromatherapy Oil Burner, Elephant Design
The Elephant design Aromatherapy Oil Burner is 6 inches high. By varying the oils and combinations, you will be able to change the atmosphere in your surroundings.
Bloodroot Root (Sanguinaria Canadensis) Powder, 4 oz. Bulk
BloodRoot (Sanguinaria canadensis) is chiefly used as an expectorant for chronic bronchitis and as a local application in chronic eczema, specially when secondary to varicose ulcers. Of value in pulmonary consumption, nervous irritation and helpful in lowering high pulse, and in heart disease and weakness and palpitation of heart of great use.
Cascara Sagrada (Rhamnus Purshiana) Tincture, 100% Organic, 2 fl. oz.
One of the best herbs for the entire digestive tract. It tones and increases peristaltic action without being habit forming. It promotes secretions of the stomach, liver, pancreas and gallbladder ducts.
Colon & Liver Cleanser, Truman's CAC Tea, Loose Leaf, 1/2 lb.
Use of this cleansing tea has many additional benefits: improves overall digestion; strengthens the immunity; helps to prevent cancer; makes the skin more emollient and flexible: clears the eyes; and provides an overall tonic effect on the body.
Cough / Sore Throat Syrup, Natural Cough Remedy, 100% Organic, 2 fl. oz.
Cough / Sore Throat Syrup, natural cough remedy, is 100% organic and may be used for bronchitis, croup, hoarseness, quinsy, and whooping cough.
Detoxifier Formula Tincture, 100% Organic, 2 fl. oz.
The Detoxifier Formula is made to aid the body in a cleansing program.
Echinacea With Goldenseal Root, Nature's Way, 450 mg, 100 Caps
Echinacea with Goldenseal supports the immune system.
Eucalyptus Essential Oil, 100% Pure, 4 fl. oz.
Eucalyptus Essential Oil is a potent decongestion with strong antiseptic properties. Eucalyptus Oil is used as an inhalant for asthma, diphtheria, sore throats, sinus and respiratory problems.
Eucalyptus Oil, 100% Pure, NOW Foods, 1 fl. oz.
Eucalyptus Oil is a strong antiseptic. Eucalyptus Oil is used as an inhalant for asthma, diphtheria, sore throats, sinus and respiratory problems.
Fenugreek Tincture, 100% Organic, 2 fl. oz.
Fenugreek can increase breast milk supply and reduce blood sugar.
Respir-Ease 2 (Asthma Tincture), 100% Organic, 2 fl. oz. Fenu-Thyme, Fenugreek Supplement, Nature's Way, 350 mg, 100 Caps
Nature's Way Fenu Thyme Fenugreek Supplement is a synergistic blend of fenugreek and thyme leaf. Fenugreek and Thyme are a gentle, yet they are a powerful way to support the needs of the body, provide a sense of holistic health, and nourish and strengthen the body to assist in its own healing processes. Nature's Way herbs are a natural addition to a healthy and balanced life. Fenu-Thyme blends two traditional culinary herbs which have also historically been used to support the respiratory system because of their mucilaginous properties. Recommendation: As an addition to the daily diet, take two capsules two to three times daily, preferably with food. For intensive use, may be taken up to five times daily.
Respir-Ease 2 Asthma Tincture herbal remedy is used for asthma, bronchitis, croup and emphysema.
Thyme Leaf, Nature's Way, 425 mg, 100 Caps
Thyme Leaf has been used extensively for the high thymol, phenol, and carvacol content in Thyme oil. Thyme leaf is also a popular culinary herb.
vitamin A, 100% Natural, Nature's Way, 10,000 IU, 100 Softgels
Nature's Way vitamin A is 100% natural from fish liver oil. It contains no artificial ingredients or preservatives.
Vitamin E, Natural D-Alpha-Tocopherol, Nature's Way, 400 IU, 100 Softgels
Vitamin E has potent antioxidant activity, supplies oxygen to the blood, aids in strengthening capillary walls, and plays a beneficial role in cancer and cardiovascular disease prevention, anti-aging benefits, circulation, wound-healing, immune function, nervous system function, PMS, hot flushes, diabetes, vascular disease, eye health, tissue repair, athletic performance, leg cramps, skin and hair health, and alleviating fatigue.
Zinc Lozenges With Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges
Nature's Way Zinc lozenge boosts cold season defense with zinc, widely recognized as an important nutritional support during the cold season, and echinacea pupurea, clinically shown to support the immune system, and Vitamin C, a vitally important vitamin for general health maintenance.
Herbal Remedies: Croup Information
Herbal Remedies: Croup Supplements & Products
NOTIFY YOUR HEALTH CARE PROVIDER IF...
Your child starts drooling or has difficulty swallowing.
Your child's lips and skin are pale, bluish or turn dark.
Your child's breathing does not sound better after mist treatment or develops stridor.
Your child's breathing becomes more difficult, including rapid breathing, belly sinking in while breathing, or the skin between the ribs pulling in with each breath.
Your child seems to feel worse, has a high fever, or a very sick appearance with a greater inactivity than usual when ill.
Your child is cranky or is constantly uncomfortable.
You are worried.
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