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With all of us docs working at break-neck speed, we rarely have time to dazzle patients with long and scary words anymore. Laryngotracheobronchitis is commonly known as "croup". Croup refers to any illness that is associated with a characteristic "barking" cough. By definition, it is not caused by one entity but by numerous pathogens. This is what makes it somewhat confusing. When you refer to your child as having "croup", we understand this as a special kind of cough. The most common causes are viruses. Respiratory Syncytial Virus, Influenza, Parainfluenza, and Adenovirus all head the list. This group of viruses is highly contagious and so we tend to see clusters of the disease, but not everyone infected with the virus will exhibit croup features. If croup is only a symptom, it makes sense that your child can acquire it several times over since the body will respond to several infections in the same manner. Croup is most commonly seen in the under 5 age group, but symptoms are more severe when the child is under 3 years old. Most of the time, croup is preceded by fever, runny nose and other cold symptoms.
When a virus targets the upper airways, the natural immune response results in inflammation. Attempting to cough with your upper airway inflamed produces a barky cough that sounds like a seal. Drawing in air may also produce a high-pitched sound. During the winter months, whole chorus of seals can be heard in the waiting rooms of our emergency departments in the wee hours of the morning. I think the most disturbing part for parents is how rapidly this develops. A seemingly healthy child is put to bed. The child wakes up a few hours later and it sounds like he or she is about to stop breathing. For the most part, the bark is worse than the bite, and most croups in healthy children do not need hospital care. Although children with asthma, born prematurely, or those with narrow airways can develop severe and even life-threatening states. Croupy coughs tend to stand out at night because there is a natural tendency for the airways to constrict. Moving air rapidly and forcefully when crying also deepens the cough.
Antibiotics are generally of no use in treating croup. Measures aimed at reducing the inflammation work best. This may be something as simple as cold air or the humidity of a running shower. I recall numerous occasions in the emergency department when exhausted and disheveled parents would show up in the dead of a frozen winter's night insisting that their smiling child was almost on death bed when they began their journey to the hospital. The car ride in cold air reversed the inflammation enough to make the croup component almost disappear. When children appear toxic or have difficulty breathing, they are hospitalized and placed in high humidity environments. Treatment with inhalant medications is also begun. Most respond very quickly.
Prevention is aimed at ensuring immunizations are up to date. Proper hand washing to prevent spread also helps. Because an incubation period exists, isolating the child is of little value. By the time first symptoms appear in day care groups, most children have already been exposed.
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