Croup

Latest Edit: Iva Lloyd, ND 2014-01-31 (EDT)

Croup, or laryngotracheobronchitis refers to a group of symptoms resulting from infection or inflammation of the laryngeal area. It is commonly characterized by inspiratory stridor, barking or 'seal's bark' cough, and hoarseness.

Naturopathic Assessment

Causal factors

The most common causes of croup include::

Infections

• Croup is generally caused by infections such as Parainfluenza virus types 1 (most common strain), 2, and 3 (most common cause),Influenza A and B viruses, Rhinoviruses, Respiratory syncytial virus, Spasmodic croup
• Recurrent upper respiratory tract infection

Lifestyle

• Food Reactions

• Specific foods can trigger or worsen croup including dairy, sugar, wheat or food sensitivities

Genetics and gestational factors

• Upper tracheal anatomic abnormalities (such as stricture or stenosis)

Medical Interventions

• History of prolonged or traumatic endotracheal intubation

Common Questions

• Has the child shown signs of sore throat, runny nose, or fever? These symptoms often precede or accompany croup.

• Is the child in a daycare program? The child may have acquired a viral infection that brought on croup.

• Are the symptoms relieved by sitting up rather than lying down? Severe symptoms of croup may manifest when lying down as opposed to sitting.

• Does the child have asthma? Croup can cause an exacerbation of asthma.

• Did the child cough or choke on food or a foreign object before the onset of the symptoms?

• Is the child immunized against diptheria and Haemophilus influenzae type B?

Diagnostic Testing

Diagnostic testing for croup involves:

• Checking the patient for fever. Note: temperature may only be slightly elevated, rarely reaching 39 degrees celsius.
• Determining if the stridor is intermittent or continuous.
• Listening for diminished breath sounds. Rhonchi, scattered crackles and wheezing may be associated with a lower airway disease.
• Neck radiograph: to rule out airway obstruction due to the presence of a foreign body
• A complete blood culture if severe bacterial infection is suspected
• Pulmonary function test

Related Symptoms and Conditions

Some commonly related symptoms and conditions include:

• Asthma
• Viral upper respiratory tract infection
• gastroesophageal reflux
• Infections

• Parainfluenza virus 1 (most common strain) 2 and 3 (most common cause)
• Influenza A and B viruses
• Rhinoviruses
• Respiratory syncytial virus
• Adenoviruses
• Enteroviruses
• Mycoplasma pneumoniae
• Rubeola (measles)
• Herpes simplex
• Cytomegalovirus
• Staphylococcus aureus
• Aspergillosis

Characteristics

Croup is often characterized by the following:

• Inspiratory stridor, 'seal's bark' cough, tachypnea, and hoarseness
• Symptoms which are exascerbated while lying on back or at night
• Diagnosis based on exclusion of epiglottitis or bacterial tracheitis
• Hallmark of having a fluctuating course, which worsens at night
• Commonly caused by a viral infection of the upper and lower respiratory tract in young children and can also be allergy based

Common Symptoms

Symptoms of croup often include:

• Rhinorrhea
• Sore throat
• Hoarseness and 'barking cough'
• Shortness of breath

Signs include:

• Inspiratory stridor, sometimes accompanied by chest wall retraction
• Rales, rhonchi, wheezing, and stridor on expiration in severely affected patients who may have lower respiratory tract infection
• Respiratory rate elevated to 35 to 45 breaths per minute. This may decrease in patients with severe croup due to severe upper airway obstruction
• Croup often presents with a fluctuating course, worsening or improving within an hour, but often worsening at night.