Presentation
The characteristic barking cough and hoarseness may be present, but there is no stridor at rest. A total score of 3–5 is classified as moderate croup. It presents with easily heard stridor, but with few other signs. [en.wikipedia.org]
Clinical Presentation This condition typically presents in children ages 6 to 36 months. Younger children typically present with hoarseness and a barking cough, whereas signs of lower airway disease are rarely seen. [hosppeds.aappublications.org]
Most children presenting to general practitioners will fall within this category. As illustrated in Scenario 1 ( Box 3 ), there may be mild chest-wall retractions and mild tachycardia, but stridor at rest will not be present. [mja.com.au]
The child presenting with croup has usually been healthy until the time of presentation and, with the possible exception of reactive airway disease or asthma, is no more likely to have underlying conditions than the general pediatric population. [clinicaladvisor.com]
The characteristic barky cough is present, but there are no other signs of viral illness. The child is perfectly fine the next morning, only to have a repeat of symptoms the next 2 or 3 nights. Hospitalization is rarely required. [medical-dictionary.thefreedictionary.com]
Entire Body System
- Swelling
An infection causes a swelling and outpouring of secretions in the voice box, the windpipe and the larger airways going to the lungs. The air passages of young children are made narrower because of the swelling. [healthcentral.com]
The moisture can help to reduce the swelling of your child�s vocal cords. Alternatively, you can use a cool mist humidifier by your child�s bedside or go for a 10 to 20 minute walk in the cool night air to reduce the swelling. [itsamomsworld.com]
Croup affects the upper respiratory tract and causes swelling and increased mucus production. [healthcommunities.com]
Respiratoric
- Cough
When the voice box and upper airway organs become inflamed, there is slight fever and a croupy cough. Severe inflammation causes barking, noisy inspiration and a metallic cough. [standardfirstaidcourses.ca]
Coughing is sometimes severe at night or when the child is crying or excited and happens with loud and raspy breathing. Coughing is similar to the barking of a seal. [standardfirstaidtraining.com]
As the upper airway becomes more inflamed and swollen, the child may become hoarse, with a harsh, barking cough. This loud cough, which is characteristic of croup. [ufmcpueblo.com]
Symptoms Croup features a cough that sounds like a seal barking. Most children have what appears to be a mild cold for several days before the barking cough becomes evident. [herbmuseum.ca]
As evening approaches an occasional hollow, barking, evidently painful cough is noticed and the voice is very hoarse; toward midnight the cough becomes more brazen and more frequent and the breathing difficult. [chestofbooks.com]
- Stridor
Our results show that stridor in this patient was due to dynamic inspiratory constriction of the vocal cords. [ncbi.nlm.nih.gov]
When you should think about other causes of “recurrent croup” – that it might NOT BE CROUP : stridor lasts for hours stridor that lasts for longer than the infection severe stridor that requires multiple ER visits severe stridor that requires hospitalization [boogordoctor.com]
The characteristic barking cough and hoarseness may be present, but there is no stridor at rest. A total score of 3–5 is classified as moderate croup. It presents with easily heard stridor, but with few other signs. [en.wikipedia.org]
The primary distinction: stridor is a sign of airway obstruction, whereas croup is a syndrome that can cause stridor. [americannursetoday.com]
- Inspiratory Stridor
Our results show that stridor in this patient was due to dynamic inspiratory constriction of the vocal cords. [ncbi.nlm.nih.gov]
Inspiratory stridor in croup. Stridor Audio file courtesy of David W. Cugell, MD. The obvious respiratory distress and harsh inspiratory stridor are the most dramatic physical findings. Auscultation reveals prolonged inspiration and stridor. [merckmanuals.com]
Bilateral vocal-cord paralysis produces a high-pitched inspiratory stridor. (Stridor doesn’t occur in unilateral vocal-cord paralysis.) Congenital subglottic stenosis causes stridor that’s commonly biphasic or inspiratory. [americannursetoday.com]
- Common Cold
Many cases come from parainfluenza viruses (the common cold). [healthline.com]
It is called spasmodic because the inflammation of the larynx is sudden and happens at night with mild common cold. [standardfirstaidtraining.com]
This type of croup is only one form of the condition and usually results suddenly when people have illnesses like rhinoviruses (common colds). [wisegeekhealth.com]
It is called spasmodic because the laryngeal inflammation is sudden, almost invariably during the night and is preceded by mild common cold. The organism responsible for croup is a virus which causes influenza and common cold. [tandurust.com]
- Dyspnea
Spasmodic croup (laryngismus stridulus) occurs at night clinical picture similar to that of viral croup. symptoms begin suddenly and are characterized by a sudden onset of dyspnea barklike cough stridor in a previously healthy child. [johnsarm.net]
Indication for hospitalization Cyanosis Not improving or getting worse Decreased alertness Family anxious about the child's condition No guarantee of follow-up References Ramboud-Cousson, Annie Bacterial Tracheitis among Children Hospitalized for Severe Dyspnea [pedclerk.bsd.uchicago.edu]
Other symptoms include dyspnea, hoarseness, stridor, and wheezing. 1 Symptoms are worse at night, peak between 24 and 48 hours, and generally resolve within one week. 5, 10 Agitation and crying tend to aggravate symptoms, and children often prefer to [aafp.org]
Croup usually is self-limiting; dyspnea and stridor typically arise as the patient starts to recover from the illness. Respiratory distress from croup varies from mild to moderate; it rarely progresses to upper airway obstruction. [americannursetoday.com]
Gastrointestinal
- Dysphagia
Three D's-drooling, dysphagia, and distress. If you suspect epiglottitis, child needs to be prepared for intubation with ENT and anesthesiologist available. Diagnosis by visualization of an enlarged, very red epiglottis. [pedclerk.bsd.uchicago.edu]
Foreign body Laryngotracheitis (viral croup) Barking cough, coryza Low-grade fever, nasal flaring, respiratory retractions, stridor Generally not indicated Parainfluenza virus types 1 to 3, influenza, respiratory syncytial virus Peritonsillar abscess Dysphagia [aafp.org]
Eyes
- Redness of Eye
[…] being red or blue in the face. [draxe.com]
Psychiatrical
- Hunger
Abnormal hunger. [Dorland] Lithiasis /Calculi The formation of stony concretions or calculi in any part of the body, especially in the bladder and urinary passages. [archaicmedicalterms.com]
Neurologic
- Confusion
A clinician advised me that: 'Stridulous croup should not be confused with 'croup with stridor'. They are different clinically (all croup has stridor; stridulous croup is severe croup and would be treated with Adrenalin)'. [remote.health.vic.gov.au]
Croup is not to be confused with Whooping Cough, a much rarer disease characterized by coughing fits. We are always happy to evaluate children with croup but it can be managed well at home in most cases with rest, time an a little TLC. [unionvillepediatrics.com]
Conditions that may be confused with Croup Epiglottitis can occur in children ages 2 to 6 years. This type of croup is rare but very serious, and sometimes fatal, and is caused by a bacterium called Hemophilus influenza type b (Hib). [healthcentral.com]
- Lethargy
[…] a fast heartbeat with severe obstructive symptoms Impending respiratory failure Level 12 to 17 barking cough, but often not prominent audible obstruction during rest that may occasionally be hard to hear retractions of the chest wall lethargy or decreased [medicalnewstoday.com]
Assessment of severity MILD MODERATE SEVERE Behaviour Normal Some/intermittent irritability Increasing irritability and/or lethargy Stridor* Barking cough Stridor only when active or upset Some stridor at rest Stridor present at rest Respiratory Rate [rch.org.au]
FAILED BREATH THREATENING: Cough sometimes isn't clear, stridor (+), impaired consciousness, and lethargy. [doktermudatrader.blogspot.com]
Some danger signs to watch for include: Labored breathing with flaring nostrils or retractions Blueness of the lips or fingernails Restlessness or confusion Sleepiness or lethargy Severe bouts of coughing that last for more than one minute and interfere [drugs.com]
Workup
(See Prognosis, Clinical, and Workup.) Patient education For patient education information, see the Lung Disease and Respiratory Health Center, as well as Croup. [emedicine.medscape.com]
Differential Diagnosis of Children with Severe Respiratory Symptoms Condition History Physical examination Workup Common etiologies Angioedema Detailed questioning to identify the offending antigen Swelling of face and neck Epicutaneous skin testing or [aafp.org]
Treatment
Treatment, and response to treatment, are also similar. Bacterial croup may be divided into laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. [en.wikipedia.org]
No child was clinically worse 2 h after treatment than before treatment. [bmb.oxfordjournals.org]
Treatment Treatment for croup will depend on the severity of the symptoms. In some cases, treatment may just involve inhaling a cool mist as was done in the olden days when treatment options were limited. [medic8.com]
Since, in most cases, the pediatrician will be able to differentiate between LT and SC at admission by history and clinical signs, it seems that steroid treatment should be avoided in cases of LT and may be of benefit in some cases of SC. [ncbi.nlm.nih.gov]
Prognosis
(See Prognosis, Clinical, and Workup.) Patient education For patient education information, see the Lung Disease and Respiratory Health Center, as well as Croup. [emedicine.medscape.com]
Prognosis: —The prognosis is good, death seldom occurring from spasmodic croup. Treatment: —The treatment of the inflammatory form is simple and effectual, the entire train of symptoms may be abated in some cases by the use of aconite alone. [henriettes-herb.com]
Prognosis: Viral croup is usually a self-limited disease The prognosis for croup is excellent, and recovery is almost always complete. [slideshare.net]
Etiology
Croup is the most common etiology for hoarseness, cough, and onset of acute stridor in febrile children. Symptoms of coryza may be absent, mild, or marked. [emedicine.medscape.com]
An allergic etiology is suspected. Antihistamines are sometimes helpful. References in periodicals archive ? Corticosteroid treatment of laryngotracheitis vs spasmodic croup in children. [medical-dictionary.thefreedictionary.com]
Among the noninfectious etiologies of this syndrome are foreign body aspiration, trauma (eg, due to intubation), and allergic reaction (eg, acute angioneurotic edema). [pedsinreview.aappublications.org]
Epidemiology
(See Etiology, Epidemiology, Prognosis, Clinical, and Treatment.) Croup manifests as hoarseness, a seal-like barking cough, inspiratory stridor, and a variable degree of respiratory distress. [emedicine.medscape.com]
Studies suggest a specific association between croup and the novel coronavirus NL63. [ 4 ] Epidemiology Croup most often affects children aged 6 months to 3 years, with a peak incidence during the second year of life. [patient.info]
Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. Pediatrics. 2006;118(4):1418–1421. 22. Chan A, Langley J, Leblanc J. Interobserver variability of croup scoring in clinical practice. [aafp.org]
Pathophysiology
The most common secondary bacterial pathogens include Staphylococcus aureus, Streptococcus pyogenes, and S. pneumoniae 18. pathophysiology 19. pathophysiology • Like most respiratory infections, the initial site of infection is thought to be the nasopharynx [slideshare.net]
Pathophysiology The infection causes inflammation of the larynx, trachea, bronchi, bronchioles, and lung parenchyma. Obstruction caused by swelling and inflammatory exudates develops and becomes pronounced in the subglottic region. [merckmanuals.com]
Pathophysiology Viral upper respiratory tract infection (URTI) causes nasopharyngeal inflammation that may spread to the larynx and trachea, causing subglottal inflammation, oedema and compromise of the airway at its narrowest portion. [patient.info]
Pathophysiology Subglottic infection, inflammation and edema Tracheal edema at the most narrow aspect of a child's airway Subglottic area is 4 mm in a typical infant (and croup may decrease this to 2 mm area) Every mm of airway area lost results in a [fpnotebook.com]
Prevention
Make sure hot water vaporizers should be out of reach of children in order to help prevent accidental burns. [standardfirstaidcourses.ca]
Prevention To help prevent viral infections that can cause croup: Wash your hands frequently, especially after you blow your nose. Also, wash your hands after you care for someone who has a cough, cold or sore throat. [drugs.com]
Her pediatrician diagnosed asthma and she began to use albuterol and Flovent, which the doctor said would prevent scar tissue from developing in her lungs. [inside.akronchildrens.org]
Repeat this remedy to reduce symptoms of croup in babies. 11 Home Remedies For Croup Treatment & Prevention Tips Prevention Tips Before we move ahead towards the prevention tips lets recall the reasons what causes croup. [homeremediesblog.com]