Croup is a common childhood disease that often strikes during the late autumn and early winter months. It’s a respiratory tract illness that’s best known for causing a sudden onset of barking cough and breathing difficulty in the middle of the night, in a child who was seemingly healthy at bedtime.
The name originates from the 18th century word ‘croup’, which meant ‘to cry hoarsely’. It occurs due to inflammation and swelling of those important airway structures, the larynx, trachea and occasionally the bronchi. Croup mainly affects babies and toddlers between the ages of six months and three years, although it can occur in older children. It is more common in boys, and anxious or excitable children.
Before 1826, diphtheria was the only known cause of croup. In 1826, viral croup was identified, which the French then called ‘faux-croup’, as the word ‘croup’ referred to diphtheritic croup. Croup due to diphtheria is now nearly unknown.
What causes croup?
Croup can be due to an infection or spasmodic in nature. Influenza viruses are the most common cause of infectious croup, although viruses like adenovirus, respiratory syncytial virus and rhinovirus may also be the culprits. These viruses are spread through inhalation or direct contact with respiratory secretions, or from direct contact with contaminated items.The infected areas of the larynx and trachea swell, after which the infection starts to spread. Because this area is the narrowest part of a small child’s airway, swelling can significantly reduce air flow. There is usually a gradual onset of fever.
In spasmodic croup swelling occurs without inflammation. Although a viral illness could trigger this, the swelling is usually in response to an allergen. Spasmodic croup tends to recur in a susceptible child, which is why it’s known as ‘recurrent croup’. There is often a hereditary element to spasmodic croup, it’s often accompanied by reflux symptoms, and it’s unusual for the child to have a fever.
The inflammation and swelling partially obstruct the airway, resulting in a barking cough, hoarseness, wheezing, noisy or difficult breathing, blueness of lips and fingernails, and the chest pulls in as it uses accessory muscles to aid breathing. Croup symptoms can range from fairly mild to severe. Warning signs of severe illness include abnormally rapid breathing and heart rate, floppy muscles, lethargy and blue tinges to skin and nails.
Home and medical treatment and outcomes
A croup attack is as frightening and upsetting to the parents as it is to their child. These five tips for at-home care will help you:
- Carefully observe your child for warning signs of breathing distress, and seek medical attention if necessary, or if the symptoms do not resolve fairly quickly.
- Anxiety and persistent crying increase airway demands, so try to keep your child as calm as possible.
- The soothing vapours of eucalyptus oil can help disinfect and open the airways – add a few drops to your child’s bathwater or a humidifier.
- Self-help homeopathic remedies for cough, mucus and inflammation can help treat mild croup symptoms and relieve anxiety.
- Massage your child’s upper back between the shoulder blade and spine on both sides – this will stimulate acupoints to support lung function and boost immunity.
Medically, croup is treated with steroids to reduce swelling, and nebulisation may be recommended – this can quick relief which lasts for up to two hours. However, the child needs to be carefully watched for at least three hours after an inhalation, as it could lead to a rebound airway spasm, which will make symptoms worse. Symptoms can last for up to two weeks, although they usually improve within three to seven days. Complications are rare, but include secondary bacterial infections. Children may struggle to drink enough fluid while they feel ill, so you’ll have to encourage frequent intake of small amounts throughout the day and night.
Moist air for croup
A common home treatment for croup is to fill a room with warm, moist air by running a hot bath or shower, or by boiling a kettle. Despite controversy in current research on whether this method is effective, many parents report that it helps to relieve their children’s symptoms when the prevailing climate is cold and dry. Care should be taken to avoid burning and scalding.