Does your little one have this "barking" cough? Let's talk about croup!

Has your little one suddenly developed a strange, barking cough along with a cold, and had difficulty breathing? As a mother, you must be very scared when that happens, right? Croup is a condition that is common among young children and shows these symptoms. Today, we will talk about this in detail, very simply.

What is this croup?

Simply put, croup, or in medical terms, ``Laryngotracheobronchitis`` is an infection of the throat, that is, the larynx (where the sound comes when we speak) and the trachea (the main tube for breathing) in young children . What happens in this is that the upper part of the airway, that is, the part below the vocal cords, swells. Imagine, when a water pipe is blocked, it is difficult for the water to pass through, when the airway swells in this way, it narrows. Then the little one finds it difficult to breathe, and a strange sound starts to be heard when breathing.

This is most common in babies and young children under the age of 3. As children get older, their airways become larger, so this type of swelling is less likely to cause significant breathing problems. This is why older children are less likely to develop croup.

The main cause of this is viral infections . Just like the viruses that cause colds and flu, not all viral colds turn into croup.

What does a croup cough sound like?

The main and most distinctive feature of croup is this strange cough . It is a harsh, harsh "barking" cough, like a seal roaring or a small dog barking. Some mothers come to me worried and say, "Doctor, my baby suddenly had a barking cough, and I was very scared." That's what it sounds like.

Another thing is that when the baby inhales, a "whooping" or choking sound may be heard coming from the throat . In medicine, we call this stridor . This sound is caused by the airway being swollen and narrowed, and the vibration that occurs when air passes through that narrowed space.

What are other symptoms?

Croup is usually mild and resolves within a few days. However, sometimes the symptoms can be severe. Most often, the symptoms start slowly. At first, they are like a mild cold, with a runny nose and stuffy nose. Then, within 12 to 48 hours, you may develop a characteristic barking cough. These symptoms often worsen at night .

Other symptoms that may be seen in mild croup include:

• Hoarseness of voice, feeling of heaviness.
• Normal fever.
• Sometimes a skin rash.
• Redness of the eyes (conjunctivitis).
• Swollen lymph nodes in the neck (neck lymph node swelling).

In moderate to severe croup, these symptoms may be severe:

• Obvious difficulty breathing : The baby seems to be having a hard time breathing.
• Restlessness, agitation.
• Retractions (drawing in of the skin between the breastbones and on the upper chest) when breathing : This shows how much difficulty the baby is having in breathing.
• Blue skin (cyanosis) : Blue skin, especially around the lips, tongue, and fingernails, means that the body is not getting enough oxygen. This is an emergency!

What is the difference between croup, RSV, and whooping cough?

All three of these diseases affect the respiratory system and can sometimes be confused because they occur in young children. Let's look at the differences.

RSV and Croup

RSV (Respiratory Syncytial Virus) is another virus that affects the respiratory system. It can affect both infants and adults. RSV causes cold-like symptoms such as coughing and sneezing. Importantly, RSV is also a type of virus that can cause croup. This means that an RSV infection can develop into croup in some children.

Pertussis and Croup

Whooping cough, or ``Pertussis'' as it is medically known, is a respiratory infection that affects young children, just like croup. Both have a distinctive cough. However , whooping cough is a cough that is accompanied by a high-pitched "whooping" sound when the person inhales.

The main difference is that whooping cough is caused by a bacterial infection, while croup is often caused by a viral infection. Therefore, there is no vaccine to prevent croup, and it cannot be treated with antibiotics (antibiotics do not kill viruses). There is a vaccine to prevent whooping cough, and it does not get better quickly like croup.

How common is croup?

In countries like the United States, it is said that about 3% of children develop croup each year. Croup is also reported to be the cause of 7% of hospitalizations in children under the age of 5. It is seen slightly more often in boys. But there is nothing to worry about, because only 85% of children who develop croup have a mild condition. Less than 1% develop a severe condition.

What are the causes of croup?

As we have already discussed, the main cause of croup is a viral infection. Of these, the most common is the virus called `(Parainfluenza virus). Apart from that, viruses like `(Influenza virus)` (the virus that makes us sick), `(RSV - Respiratory Syncytial Virus)`, measles virus, and `(Adenovirus)` can also cause croup. These viruses cause the airways at the top of the child's throat to swell. This makes it difficult to breathe.

But these viruses are common in the environment. This means that not every child who gets a viral infection will develop croup. Very rarely, a bacterial infection can occur in addition to the viral infection, making the condition worse.

Is croup contagious?

Yes, croup is a highly contagious disease because the viruses that cause it spread very easily.

When someone with a viral or bacterial infection that can cause croup coughs or sneezes, tiny droplets (respiratory droplets) are released into the air. If your child breathes in that air, they can get the germs and get croup. They can also get it by touching objects that are contaminated with germs, such as toys or doorknobs, and then touching their mouth or nose with the same hand.

A child can be contagious for the first three days after symptoms start, or until the fever has completely subsided . Therefore, it is important to avoid sending your child to school until the fever has subsided for 24 hours without giving them fever-reducing medication.

Can croup cause complications?

Most of the time, croup is a mild condition that can be treated at home. Complications are rare. Less than 5% of children with croup need to be hospitalized. Your child may need to be hospitalized if:

• If you need to give oxygen to maintain the oxygen level in the child's body.
• If you have severe dehydration and need to be given fluids through a vein (IV - intravenous) .
• If you need to give several nebulized breathing treatments for difficulty breathing.
• If symptoms persist after initial treatment.

How do I know if my baby has croup?

Most of the time, a doctor will decide whether your child has croup based on the symptoms the child is showing . The main ones are that characteristic barking cough and the ``stridor`` sound that is made when breathing. This is especially seen in the fall and winter (in our country, during the rainy season, when it is very cold). If the child's condition is severe, the doctor may sometimes order X-rays and lab tests, but this is very rare.

How is croup treated?

Treatment depends on the severity of your child's symptoms and the risk of the condition getting worse quickly. If your child has had breathing problems before, or if they were born prematurely, this will also affect the choice of treatment.

Home remedies (for mild croup)

If the condition of croup is mild, it can often be treated and cured at home.

Important: If your child's condition does not improve with these home remedies, or if it seems to be getting worse, be sure to see a doctor.

• Cool mist humidifier: Using a cool mist humidifier, which adds moisture to the room, can help relieve dry, stuffy breathing.
• Bathroom steam: Close the bathroom door and turn on the hot water from the shower. Then, stay in the steamy bathroom with your child for a while. But be careful! Don't touch the child in the shower or bring them near the hot water, as it can burn them.
• Cool air: If your baby seems to be having trouble breathing at night, open a door or window to let some cool air into the room (but don't expose them to extreme cold).
• Fever medicine: If you have a fever, give a doctor-prescribed (OTC) medicine such as paracetamol (e.g. Panadol, Calpol) or ibuprofen (e.g. Brufen). Do not give aspirin to young children.
• Warm liquids for cough: Giving warm, clear liquids (e.g. soup, lukewarm water) in small amounts can help loosen the mucus in the vocal cords.
• Avoid smoking: Avoid smoking indoors. Cigarette smoke can make your child's cough worse.
• Elevate the head: While sleeping, prop your baby's head up with an extra pillow. This can help them breathe more easily. But don't put a crib on a baby under a year old.

If possible, it's best to sleep in the same room as your child, so you can be aware if your child has difficulty breathing at night.

Medical Treatment (For Moderate to Severe Croup)

If the croup is moderate or severe, you should immediately take your child to the nearest Emergency Department (ETU) or a doctor. Severe croup can be life-threatening, so it is not advisable to delay.

The treatments given there may vary depending on the child's symptoms. Some of these include:

• Giving humidified air or oxygen.
• If dehydration occurs, give IV fluids.
• Monitoring vital signs: things like oxygen levels, breathing rate, and heart rate.
• Specific medications for croup: steroids (glucocorticoids) and nebulized medications (e.g. epinephrine).
• If breathing difficulties are severe, mechanical ventilation may be performed in rare cases.

Let's learn a little more about these medications.

When you take your child to a doctor or emergency room, the doctor may give you a type of medicine called a ``glucocorticoid'' and a ``nebulized epinephrine''.

• Glucocorticoids:

These are a type of steroid. This medicine works by reducing swelling in your child's larynx (voice box). It usually starts working within 6 hours of the first dose. Giving this medicine to a child with mild croup can help reduce the need for repeated visits to the doctor or hospital.

The most commonly used medications are `(dexamethasone)` and `(prednisolone). These are given by mouth, usually in a single dose. If the child is vomiting and cannot keep the medicine down, `(dexamethasone)` can be given intravenously `(IV)` or intramuscularly `(IM injection)`.

• Nebulized Epinephrine:

Epinephrine is given as a mist through a nebulizer. It also works by reducing swelling in the airways. It usually starts working within 10 minutes. However, its effects only last about two hours. Therefore, if symptoms are severe, you may need to repeat the treatment every 15 to 20 minutes.

Are there any side effects of the treatment?

Epinephrine rarely causes serious side effects. However, it can cause things like an increase in heart rate (tachycardia). A doctor will monitor the child for three to four hours after the last dose to see if breathing problems return.

How quickly will I recover after treatment?

Glucocorticoids usually start working within 6 hours of the first dose. Epinephrine starts working even faster.

When should you be concerned about croup?

Croup can be mild, moderate, or severe. It depends on how hard it is for the child to breathe in . The severity of the condition depends on the size (diameter) of the child's airway and how much it is narrowed by swelling. Also, the condition can get worse if the child is upset or cries.

• Mild Croup:

A child with mild croup may have a barking cough and a wheezing sound (stridor). Symptoms may be worse at night. So you need to be careful about your child's breathing, but in most cases, they can be treated at home.

• Moderate Croup:

A child with moderate croup may have a wheezing sound (stridor) and signs of retractions (the skin between the ribs) when breathing. They may be a little agitated, confused, and have moderate difficulty breathing. At this point, the child should be taken to a doctor for treatment.

• Severe Croup:

A child with severe croup will have both stridor and retractions. They may be very agitated, restless, and tired.Blue discoloration of the skin (cyanosis) is common. Severe croup is life-threatening! Take the child to an emergency room (ETU) immediately.

How long does croup last?

Most children recover from croup symptoms within two days , but sometimes symptoms can last up to a week.

When can I send my baby back to school?

Croup is a highly contagious illness. Avoid sending your child to school until their fever is completely gone (they should be fever-free for 24 hours without giving fever-reducing medication).

How to prevent the spread of croup?

Croup can be spread by contact or through the air. To prevent it, do these things:

• After caring for the baby , wash your hands thoroughly with soap and dry them.
• Wash toys thoroughly after use.
• Teach your child to cover their mouth and nose when coughing or sneezing.
• Avoid sending your child to school/daycare centers when they are sick, or if the disease is spreading in places like school.
• Dispose of used tissues properly.

When should I see a doctor? / When should I go to an emergency room?

In this case, talk to your child's doctor :

• If the child has a fever for more than three days .
• If you have mild croup symptoms for more than a week .
• If you have questions or concerns about your child's condition.

If you see any of the following symptoms, take your child to an emergency room (ETU) immediately:

• If there is obvious difficulty breathing .
• If the skin turns blue (cyanosis) (especially around the lips, tongue, and fingernails).
• If the severe cough persists.
• If you have difficulty swallowing, or if saliva escapes from your mouth.
• If you can't breathe, you can't scream.
• If you make a high-pitched whistling sound when you breathe.
• If the skin between the breastbones and on the upper chest pulls inward (retractions) when breathing.

Why does my baby keep getting croup?

If your child keeps getting croup, it could be a sign that there is a narrowing of their airways . This makes them more susceptible to infections. This narrowing may be present at birth or may develop later. If croup keeps getting worse, your doctor may refer you to an ear, nose and throat specialist (otolaryngologist) or a respiratory specialist (pulmonologist) .

Can adults get croup?

Adults can get croup, but it's very rare. Babies and young children get croup because their windpipes (tracheas) are narrow and not fully developed. As children get older, their windpipes get bigger and more fully developed. Even if they get swelling, it won't affect breathing much. Because adults have larger airways, croup usually doesn't affect them. However, if an adult gets croup, their symptoms can usually be more severe and they may need urgent treatment.

The most important things you need to remember (Take-Home Message)

Croup is a highly contagious respiratory infection that affects babies and young children. You can tell if it's croup by the distinctive "barking" cough your child has. Most of the time, croup is mild and goes away on its own, but sometimes it can quickly get worse and make it difficult for your child to breathe.

So, if your child's croup doesn't get better, or seems to be getting worse, don't delay and see a doctor for a checkup and treatment. The most important thing is to not panic and do the right thing. You are not alone, we are all with you!

` Croup, Barking cough, Childhood diseases, Respiratory infections, Stridor, Difficulty breathing