American Medical Association Family Medical Guide - American Medical Association [196]
Croup
Croup is inflammation and swelling of the trachea (windpipe) caused by a viral infection of the respiratory tract. The swelling narrows the trachea and causes hoarseness, noisy breathing, and a loud, barking cough.
Diagnosis and Treatment
A diagnosis of croup is based on a child’s symptoms and a physical examination. The doctor may order X-rays to determine if the symptoms are caused by croup or by epiglottitis (see illustration).
Epiglottitis
Epiglottitis is a life-threatening condition in which the epiglottis (a flap of cartilage at the top of the trachea) becomes infected, swells, and blocks the airway. To treat epiglottitis, a doctor guides a tube through the child’s mouth and down the throat to open the airway. The child is admitted to an intensive care unit and given antibiotics intravenously (through a vein).
If your child has an episode of croup, stay calm and reassure him or her. Give your child plenty of fluids and, if he or she has a fever, give acetaminophen or ibuprofen (not aspirin). You may be able to relieve your child’s symptoms by exposing him or her to cooler air by using a cool-mist vaporizer in his or her bedroom. Sitting with your child in a bathroom filled with steam from a hot shower can help relieve congestion and make breathing easier.
The doctor will probably prescribe an aerosol corticosteroid medication to relieve inflammation and swelling in the trachea, or aerosol epinephrine (a hormone produced by the adrenal glands) to improve breathing. The doctor may also prescribe corticosteroid drugs to be taken orally or injected. This treatment can be administered in the doctor’s office or in a hospital emergency department. A child who has severe difficulty breathing or cyanosis (blueness of the skin caused by lack of oxygen in the blood) will be hospitalized for treatment with supplemental oxygen and medication. If the doctor suspects epiglottitis, the child will be admitted to the hospital intensive care unit immediately for emergency medical treatment.
If a child’s airways are severely obstructed by severe croup or epiglottitis, the doctor will pass a tube through the child’s mouth down into the throat to open the airway or, in severe cases, make a small incision in the throat and insert a breathing tube. The tube is usually removed within 24 to 72 hours. In rare cases, a child’s breathing must be maintained with a ventilator (an artificial breathing machine). Children are admitted to a hospital for this treatment, and recover completely within a few days.
WARNING!
Difficult or Noisy Breathing
If a child inhales a foreign object, it can partially or completely block the airway (trachea) and interfere with breathing. If the child’s airway is partially blocked, he or she will wheeze or grunt and may cough. In this case, a doctor will perform a procedure called bronchoscopy (an examination of the inside of the lungs with a viewing tube called a bronchoscope) to look for the inhaled object and, if possible, remove it.
If an inhaled object passes farther down into the lungs, it can cause inflammation and infection. In this case, the doctor will use a bronchoscope to locate and remove the object and may prescribe antibiotics to treat or prevent an infection.
If your child has sudden difficulty breathing, if his or her lips look blue, or if he or she is breathing noisily, call 911 or your local emergency number, or take him or her to the nearest hospital emergency department immediately.
Bronchiolitis
Bronchiolitis is a potentially life-threatening viral infection of the lungs in which the lining of the bronchioles (the smallest airways in the lungs) swells and produces secretions that block the passage of air into and out of the alveoli (the tiny sacs through which oxygen and carbon dioxide are exchanged between the lungs and the blood). The