Croup

“Help, my child is barking!” Any parent that has been through this barking experience can testify that croup is not just a cough. Let us take a closer look at crou

Croup or laryngotracheo-bronchitis is an acute inflammation and obstruction of the upper respiratory tract. It involves the larynx, the trachea and the bronchi. Croup is the paediatric equivalent of acute laryngitis that we find in adults. Babies and toddlers from three months up to four years of age can be affected.

Causes: The usual cause is a viral infection, but secondary bacterial infections can also be present. The rubeola virus causes measles whist the influenza virus is responsible for flu. Haemophilus influenza type B is a bacterium that causes meiningitis, otitis media and pneumonia in infants. Thus, croup can be associated with other diseases.

Signs and symptoms: There is a history of an upper respiratory tract infection followed by difficulty in breathing (stridor) and hoarseness. The typical croup-bark (cough) is initially dry and later becomes moist and productive due to the inflammation of the bronchi.  Other signs and symptoms may include:

⌂   restlessness

⌂   cyanosis or a blue-grey complexion colour

⌂   fever

Treatment: Rapid and correct treatment is required to prevent death from suffocation. It is important to refer the following cases to the general practitioner:

⌂   any evidence of pneumonia and respiratory distress

⌂   difficult breathing or stridor

The doctor will initiate correct treatment which normally includes nebulisation with corticosteroid agents.

Preventative and supportive treatment: The following supportive actions can be initiated:

⌂   Pain and fever: Nurofen® (ibuprofen and paracetamol) or Panado® (paracetamol) to reduce fever. Ibuprofen has anti-inflammatory actions as well.

⌂   Food and hydration: Give the following advice to the parent of the affected toddler:

• provide smaller meals. Large volumes of food will increase the pressure on the diaphragm that can aggravate the difficulty in breathing
• frequent fluids in small amounts, because children lose fluid from the lungs

⌂   Keep the toddler calm as crying will make the obstruction worse.

⌂     When the baby is in an upright, sitting position the breathing will be easier.

⌂   Humidification:

• Add Karvol^® to the medication compartment of a humidifier. Karvol contains menthol, thymol, pine  and cinnamon oil. When added to the compartment, it releases the aromatic vapours of the oils. The active oils have decongestant actions on the upper respiratory tract, giving symptomatic relief of nasal congestion and bronchitis.
• Puma Balm contains clove oil, eucalyptus oil, methyl salicylate, oil of amber, camphor and menthol in an ointment base. Puma can be applied to the chest and nostrils and will provide decongestant aromatic vapours. It is important that Puma Balm should not be applied to broken skin, open wounds, eyes or on mucous membranes.

Conclusion: Croup is a potentially life threatening condition and should be treated with the utmost respect.