Also known as laryngo-tracheo-bronchitis, croup is a household term for a group of diseases characterised by swelling and partial blockage of the entrance to the LARYNX, occurring in children and characterised by crowing inspiration. There are various causes but by far the commonest is acute laryngo-tracheobronchitis (see under LARYNX, DISORDERS OF). Croup tends to occur in epidemics, particularly in autumn and early spring, and is almost exclusively viral in origin – commonly due to parainﬂuenza or other respiratory viruses. It is nearly always mild and suﬀerers recover spontaneously; however, it can be dangerous, particularly in young children and infants, in whom the relatively small laryngeal airway may easily be blocked, leading to suﬀocation.
Symptoms Attacks generally come on at night, following a cold caught during the previous couple of days. The breathing is hoarse and croaking (croup), with a barking cough and harsh respiratory noise. The natural tendency for the laryngeal airway to collapse is increased by the child’s desperate attempts to overcome the obstruction. Parental anxiety, added to that of the child, only exacerbates the situation. After struggling for up to several hours, the child ﬁnally falls asleep. The condition may recur.
Treatment Most children with croup should be looked after at home if the environment is suitable. Severe episodes may require hospital observation, with treatment by oxygen if needed and usually with a single dose of inhaled steroid or oral PREDNISONE. For the very few children whose illness progresses to respiratory obstruction, intubation and ventilation may be needed for a few days. There is little evidence that putting the child in a mist tent or giving antibiotics is of any value. Of greater importance is the reassurance of the child, and careful observation for signs of deterioration, together with the exclusion of other causes such as foreign-body inhalation and bacterial tracheitis.