Croup is a common childhood illness usually occurring in children under the age of five, however it is most common between the ages of 6 months to 3 years of age (Chandler 2002).
Boys tend to be more affected than girls in a ratio of 2:1 (Ruddy, 1993) and once a child has had one episode it is not unusual for the child to suffer from recurring episodes.
What is Croup?
Croup can be defined as a swelling to the tissues in the sub-epiglottic area of the upper respiratory tract. Webster et al (1998) use the definition "swelling of the submucosa in the subglottic area" and Dykes (2005) describes laryngotracheitis (in which the inflammation is situated around the larynx and the trachea) and laryngotracheobronchitis (where the inflammation spreads to the bronchi). Put simply croup is inflammation of the tissues in the upper respiratory tract.
What Causes Croup?
Dykes (2005) identifies the most common cause of croup is the parainfluenza virus but also cites Lissauer and Clayden (2001) who identify that the respiratory synctial virus, influenza and mycoplasma pneumoniae have similar clinical effects.
O'Callaghan and Stephenson (1992) state that most cases of croup are caused by adenovirus, parainfluenza virus or respiratory synctial virus.
Signs and Symptoms
- Sore throatA characterisitc rough barking cough
- Hoarseness and noisy breathing
- Symptoms often occur at night when the child has been lying down for a couple of hours
- The child may have a high temperature
- A wheeze may be present
- The child may be active but irritable.
Treating croup
Treatment can be divided into pharmacological and supportive.
Pharmacological Steroids help decrease subglottic oedema by suppressing local inflammatory responses. Dexamethasone can be given orally or via intramuscular injection, however orally is the preferred method of administration.
Budesonide (otherwise known as pulmicort) is a steroid that is given via an oxygen driven nebuliser and has been shown to be beneficial.
The steroids described above have been shown to have a rapid and sustained effect and although they don't improve the child's sore throat their use does reduce the need for re-attending and re-admissions to hospital (Chandler 2002).
Nebulised adrenalin can cause vasoconstriction and therefore reduce airway obstruction but it's effect is short acting at only two hours. Adrenalin can cause tachycardia and arrhythmias and children receiving this treatment should be observed for six hours before considering discharge. There is also a risk of airway obstruction reoccuring as bad or worse than before treatment because adrenalin does not have an effect on the body's inflammatory response in the way that steroids do (Dykes 2005) therefore adrenalin is used in cases of severe upper airway obstruction.
Supportive TreatmentsA commonly used home treatment is steam. This can be safely carried out in a bathroom by turning the shower on or running the hot tap. Care must be taken when using boiling kettles in that the child must be close enough to gain benefit but not too close that they are at risk of burns should they come into contact with the kettle or source of the hot water.
The abnormal barking sound made by children with croup can be frightening for both the child and the parent and as the child becomes more distressed the work of breathing becomes harder therefore it is important to stay calm and relaxed so as too soothe the child and decrease their anxiety.
ReferencesChandler T (2002) Croup Paediatric Nurse. 14,7,41-47.
Dykes J (2005) Managing Children with Croup in Emergency Departments. Emergency Nurse. 13, 6, 14-19.
Lissauer T & Clayden G (2001) Illustrated Textbook of Paediatrics. Mosby, Edinburgh.
O'Callaghan C & Stephenson T (1992) Pocket Paediatrics. London, Churchill Livingstone.
Ruddy R (1993) Croup - has Management Changed? Contemporary Paediatrics 10,21-32.
Webster H et al (1998) Pulmonary System. In Slota M (ed) (1998) Core Curriculum for Paediatric Critical Care Nursing. London, Churchill Livingstone.
