Croup can be very scary. Most know croup as the barky cough that little kids have when they are sick. But sometimes it much more than just a cough as it signals something much more concerning.
Croup, typical in young kids, ages 6 months to 3 years-old, begins as the common cold with runny nose and congestion. Parainfluenza virus is the most common cause, but really any virus can trigger croup. The inflammation and congestion begins at the level of the back of the nose (nasopharynx) and throat (oropharynx), and then progresses downward to the voice box (larynx) and windpipe (trachea).
Here’s where the potential problem begins.
The trachea has the narrowest segment just below the vocal cords, called the cricoid cartilage. Unlike the rest of the trachea, this complete ring makes this area very inflexible. The swelling of the mucosa of the trachea with croup causes this section to become even more narrow and, as such, a critical bottle neck for airflow.
The barking cough is a result of the swelling in the trachea but the stridor, or high-pitch noisy breathing, points to the narrowing of the trachea at the cricoid.
Most cases of croup will not cause this degree of swelling and most will resolve with supportive care. A small, but important subset, will need
A small, but important subset, will have a moderate to severe case that requires evaluation and intervention in the clinic or hospital setting.
When it become
When it becomes scary is when things accompany it such as drooling, retractions, breathing faster, cyanosis (turning dusky or blue).
VIDEO
This barking cough, is croup. This is a severe case as there are 2 other findings that are concerning.
The stridor, or high pitched noisy breathing……
And the increased work of breathing.
Notice how you can see the ribs here and here. The child is really working hard to breathe.
To understand the treatment, lets see why this happens.
Croup happens as a result of the common cold that spreads from the nose and throat to the voicebox and trachea, or windpipe. The mucosa, or lining, here around the windpipe swells. The problem point is here at the cricoid cartilage, just below the vocal cords, where it is the most rigid.
The most rigid part of the trachea is here at the cricoid cartilage. located just below the vocal cords, swelling here will cause a narrowing making it harder for air to flow.
Swelling here makes it so that the airflow has a smaller space to travel through. And the dynamics of turbulent flow (thanks physics) makes it harder for oxygen to get to the lungs.
So instead of an opening like this, it may be more like this.
Hence the noisy breathing and retractions.
Treatment thus is aimed at reducing this swelling, so steroids, like decadron can be helpful. A recent study also found that inhaled corticosteroids, like Flovent, if given at the start of a cold, can help to decrease the severity of croup.
I also recommend allergy and sometimes reflux meds in these kids as there is a correlation with croup.
It can be triggered by any common cold.
