爸爸决定先给她洗个热水澡，然后房间里用了Humidifier，希望能使她舒服点儿，晚上等大宝入睡之后将小宝抱回到大床上，爸爸妈妈实在放心不下啊。夜里小宝睡得极不踏实，因为高烧醒来吃药之外仍多次醒来，可能是呼吸困难，她想哭却哭不出来，只是迷糊中嘶哑地哭着找妈妈。因为怕吃多了Tylenol不好，所以吃了3次之后就让她改吃了2次Motrin。小宝喜欢Tylenol (grape)的味道，所以每次吃Tylenol她都会很乐意张开小嘴巴，但换了Motrin (original berry)，通常勉强半天爸爸妈妈一起才能喂下去，所以若是半夜里醒来要吃药，妈妈只好给她吃Tylenol。
到了医院，check in之后没有等很久护士就来叫了，小宝此时烧退了，精神似乎不错就自个撒开小腿跟着护士跑在前面，先是给小宝称体重，好象是第一次试图让小宝站秤上称体重，小宝不肯，于是合衣抱到婴儿秤上，护士拿出Dora Sticker，让小宝选自己喜欢的，在这分神的当儿，得到了她的体重，呵呵，妈妈没看仔细，后来听爸爸说是26磅。之后便到房间，护士简单问了几个问题以及谁是小宝的PED，然后就出去了。在等医生的当儿，小宝还极力想恢复原来的小调皮本色，眼睛里还出现了平常的神采，这可能是这几天唯有的几分钟。不久进来一个不认识的男PED，看来是谁available就来给生病的宝宝看病，而不必是宝宝自己的PED。
于是开了单子给我们，说是必要时给小宝出现呼吸困难时给她吸服(PED的字太难认了，还是爸爸拿了药回来才知道的)，药物名称是Ventolin HFA (Albuterol sulfate)，上面有个NOTE是“INHALE 2 PUFFS EVERY 4 HOURS IF NEEDED”；此外还买了一个简易装置，感觉是个手动的PUMP，连着个mask，按PED的意见是必要时每4小时给小宝吸服一次，每次PUMP两下。具体的名称是“AEROCHAMBER PLUS With ComfortSeal Mask-Small”，感觉是设计给宝宝用的。回来的路上小宝很快就睡着了，上了高速可能还没开到下一个出口，看她睡得香甜的样子，妈妈真是好欣慰啊，虽说小宝呼吸声还有些沉重，不过至少不是那么费劲了，这几天乖乖真是累坏了。
因为要到daycare付这个月的费用，妈妈通常都是每个月底写支票给他们，但因为小宝病了，妈妈一直守着她，没顾上，而今天已经是这个月的第一天，说什么也要付了，于是决定在小宝的daycare停一下，然后在附近的Kroger去买小宝喜欢吃的一种酸奶。小宝开始一直坐在shopping cart里，后来快check out时爸爸情不自禁说了句“What a pitiful thing!”，妈妈忍不住伸手将小宝抱起来。爸爸在将东西一个个SCAN check out的时候，小宝突然大吐起来，早上吃喝进去的一点东西都出来了，吐了自己和妈妈一身不算，还吐了一地，里面的一个工作人员赶紧拿了纸过来，爸爸赶紧向人家道谢和道歉。
顺便提一下，Croup旧称为“false croup (假性格鲁布，痉挛性哮吼)”，或bronchitis convulsive(痉挛性支气管炎)、catarrhal croup(卡他性格鲁布)。在以前白喉尚多的年代，Croup作为白喉的别名而通用，而把白喉以外引起哮吼的疾病命名为假性格鲁布。由于预防接种的关系，白喉已绝迹，如今大都只称格鲁布(Croup)。我的同事也告诉我，Croup是个很古老的词，也就是我们现在所说的Croup与以前的含义其实已经不同了。
● 尽量使您的孩子保持镇静： 哭闹只会使呼吸更困难。
● 凉爽一会： 有时候，呼吸清新凉爽的空气对病情有帮助。若室外凉爽，可用毛毯包裹孩子到外面走上几分钟。
● 鼓励孩子多休息： 睡眠有助于机体抗感染。
● 不需要给孩子服用止咳糖浆： 因为它不是因喉头气管受累引起的，因此止咳糖浆起不到缓解作用。
● Croup多在夜间加重，建议家长与小儿同居一室或使用baby monitor，以便及时了解婴儿的情况。
呼吸窘迫加重或持续不改善，心动过速，疲劳，发绀或脱水说明需要住院。由于中度低氧血症可无发绀，对呼吸窘迫的病儿开始就应该进行动脉血气分析。如果开始动脉血氧分压(PaO2 )低于8KPa(60mmHg)应该给湿化的氧。吸入氧浓度保持在30%～40%一般已足够。动脉血二氧化碳分压(PaCO2 )＞6KPa(45mmHg)说明有二氧化碳潴留，此时病人一般表现疲劳，需密切监视。气管插管应提前进行，器械和工作人员应事先做好准备。下列情况需要立即进行插管：(1)尽管给予足够的氧，雾化治疗和补液，CO2 潴留仍加重；(2)吸氧后低氧血症无改善；(3)分泌物难以咳出。
《寿世保元》 [明] 龚廷贤(公元1368年—1644年) [卷三] 哮吼
● 定义：一种急性上呼吸道阻塞疾病，副流行性感冒病毒(parainfluenza virus)感染是最常见的病因，这种病毒通常侵袭半岁至三岁的孩子，可造成通往肺部的主要气管通道发炎和狭窄，引起的不同程度喉部阻塞，对幼儿有时会引起严重的呼吸困难，需要紧急治疗(成人及年长一些的孩子由于气管较宽，因此膨胀时不大会影响呼吸)；
Croup is a condition that causes an inflammation of the upper airways — the voice box (larynx喉) and windpipe (trachea气管). It often leads to a barking cough or hoarseness嘶哑, especially when a child cries.
Most cases of croup are caused by viruses. Those involved are usually parainfluenza (副流感, 类流感) virus (which accounts for most cases), adenovirus (腺病毒), and respiratory syncytial virus (呼吸道合胞体病毒，RSV). Croup is most common — and symptoms are most severe — in children 6 months to 3 years old, but can affect older kids, too.
Most cases of viral croup are mild and can be treated at home, though rarely it can be severe and even life-threatening. Some children are more prone to developing croup when they get a viral upper respiratory infection.
The term spasmodic croup (痉挛性格鲁布) refers to a type of croup that develops quickly and may happen in a child with a mild cold. The barking cough usually begins at night and is not accompanied by fever. Spasmodic croup has a tendency to come back again (recur).
Symptoms are treated the same for either form of croup.
2、Signs and Symptoms
At first, a child may have cold symptoms, like a stuffy or runny nose and a fever. As the upper airway (the lining of the windpipe and the voice box) becomes progressively inflamed and swollen, the child may become hoarse, with a harsh, barking cough. This loud cough, which is characteristic of croup, often sounds like the barking of a seal.
If the upper airway becomes increasingly swollen, it becomes even more difficult for a child to breathe, and you may hear a high-pitched or squeaking noise when a child inhales (this is called stridor喘鸣). A child also may tend to breathe very fast and might have retractions (when the skin between the ribs pulls in during breathing). In the most serious cases, a child may appear pale or have a bluish tinge around the mouth due to a lack of oxygen.
Symptoms of croup are often worse at night and when children are upset or crying. Besides the effects on the upper airway, the viruses that cause croup can cause inflammation farther down the airway and affect the bronchi支气管 (large breathing tubes that connect to the windpipe).
Outbreaks of croup tend to occur in the fall and early winter when the viruses that cause it peak. Many children who come in contact with the viruses that cause croup will not get croup, but will instead have symptoms of a common cold.
Doctors can usually diagnose croup by listening for the telltale barking cough and stridor. They will also ask if your child has had any recent illnesses with a fever, runny nose, and congestion, and if your child has a history of croup or upper airway problems.
If a child's croup is severe and slow to respond to treatment, a neck X-ray may be taken to rule out any other reasons for the breathing difficulty, such as a foreign object lodged in the throat, an abscess behind the throat, or epiglottitis会厌炎(a inflammation of the epiglottis, the flap of tissue that covers the windpipe). Typical findings on an X-ray if a child has croup includes the top of the airway narrowing to a point, which doctors call a 'steeple sign'
Most, though not all, cases of viral croup are mild. Breathing in moist air seems to make kids feel better. And ibuprofen or acetaminophen can make a child feel more comfortable. Doctors will also sometimes treat with steroids, which help with the airway swelling.
The best way to expose your child to moist air is to use a cool mist humidifier, or run a hot shower to create a steam-filled bathroom where you can sit with your child for 10 minutes. Breathing in the mist will sometimes stop a child from severe coughing. In the cooler months, try taking your child outside for a few minutes to breath in the cool air — this may also alleviate symptoms. You can also try driving your child around in the car with the windows down.
When your child is sick, you might also want to consider sleeping overnight in the same room to provide close observation. If you are not able to break your child's fast breathing and croupy (格鲁布性的, 哮吼性的) cough, call your child's doctor or seek medical attention as soon as possible.
Medical professionals will need to evaluate your child if the croup appears serious or if there's any suspicion of airway blockage. If the croup becomes severe, doctors will give a breathing treatment that contains epinephrine (肾上腺素adrenalin). This reduces swelling in the airway quickly. Oxygen may also be given, and sometimes a child with croup will remain in the hospital overnight for observation. As with most illnesses, rest and plenty of fluids are recommended.
The symptoms of croup generally peak 2 to 3 days after the symptoms of infection with a virus start. Viral croup usually lasts 3 to 7 days.
The vast majority of children recover from croup with no complications. Rarely, children will develop a bacterial infection of the upper airway, or pneumonia. Dehydration may occur due to inadequate fluid intake.
Children who were born prematurely or who have a history of lung disease (such as asthma), or neuromuscular disease like cerebral palsy are more likely to develop severe symptoms of croup and often require hospitalization. Croup rarely causes any long-term complications.
Frequent hand washing and avoiding contact with people who have respiratory infections are the best ways to reduce the chance of spreading the viruses that cause croup.
9、When to Call the Doctor
Immediately call your doctor or seek medical attention if your child has:
● difficulty breathing, including rapid or labored breathing
● retractions: when the skin between the ribs pulls in with each breath
● stridor: high-pitched or squeaking noise when inhaling
● a pale or bluish color around the mouth
● drooling or difficulty swallowing
● a fatigued appearance
● signs of dehydration
● a very sick appearance
【Croup At A Glance】
● Croup is an infection of the larynx, trachea, and the bronchial tubes usually caused by viruses, less often caused by bacteria.
● Croup is contagious, especially during the first few days of illness.
● A cough that sounds like a barking seal and a harsh crowing sound during inhaling can be symptoms of croup.
● Treatment of croup can include moist air, saltwater nose drops, decongestants and cough suppressants, pain medication, fluids, and occasionally antibiotics.
● The major concern in croup is the accompanying breathing difficulties as the air passages narrow.
● Close monitoring of the breathing of a child with croup is important, especially at night.
Croup Glossary of Terms
Acetaminophen: A pain reliever and fever reducer. Brand name: Tylenol. The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold (that is, by requiring a greater amount of pain to develop before it is felt by a person). Acetaminophen reduces fever through its action on the heat-regulating center (the "thermostat") of the brain. Generic is available.
Aspirin: A good example of a tradename that entered into the language, Aspirin was once the Bayer trademark for acetylsalicylic acid.
Bacteria: Single-celled microorganisms which can exist either as independent (free-living) organisms or as parasites (dependent upon another organism for life).
Bacterial: Of or pertaining to bacteria. For example, a bacterial lung infection.
Brain: That part of the central nervous system that is located within the cranium ( skull ). The brain functions as the primary receiver, organizer and distributor of information for the body. It has two (right and left) halves called "hemispheres."
Breathing: The process of respiration, during which air is inhaled into the lungs through the mouth or nose due to muscle contraction, and then exhaled due to muscle relaxation.
Chest: The area of the body located between the neck and the abdomen . The chest contains the lungs , the heart and part of the aorta . The walls of the chest are supported by the dorsal vertebrae , the ribs , and the sternum .
Coma: A state of deep unarousable unconsciousness.
Common cold: A viral upper respiratory tract infection. This contagious illness can be caused by many different types of viruses , and the body can never build up resistance to all of them. For this reason, colds are a frequent and recurring problem. In fact kindergarten children average 12 colds per year, while adolescents and adults have around seven colds per year.
Cortisone: An adrenocorticoid hormone , a naturally occurring hormone made by and secreted by the adrenal cortex , the outer part (the cortex ) of the adrenal gland .
Cough: A rapid expulsion of air from the lungs typically in order to clear the lung airways of fluids, mucus, or material. Also called tussis.
Croup : A respiratory problem that occurs mainly in children, particularly from 2 to 4 years of age, due to an infection of the respiratory tree -- the larynx (voice box), the trachea (windpipe), and the bronchial tubes.
Dehydration : Excessive loss of body water. Diseases of the gastrointestinal tract that cause vomiting or diarrhea may, for example, lead to dehydration. There are a number of other causes of dehydration including heat exposure, prolonged vigorous exercise (e.g., in a marathon), kidney disease, and medications (diuretics).
Ear: The hearing organ. There are three sections of the ear, according to the anatomy textbooks. They are the outer ear (the part we see along the sides of our head behind the temples), the middle ear, and the inner ear. But in terms of function, the ear has four parts: those three and the brain. Hearing thus involves all parts of the ear as well as the auditory cortex of the brain. The external ear helps concentrate the vibrations of air on the ear drum and make it vibrate. These vibrations are transmitted by a chain of little bones in the middle ear to the inner ear. There they stimulate the fibers of the auditory nerve to transmit impulses to the brain.
Family: 1. A group of individuals related by blood or marriage or by a feeling of closeness. 2. A biological classification of related plants or animals that is a division below the order and above the genus. 3. A group of genes related in structure and in function that descended from an ancestral gene. 4. A group of gene products similarly related in structure and function and of shared genetic descent. 5. Parents and their children. The most fundamental social group in humans.
Fever : Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.).
Humidifier: Anything, usually a machine today, that adds moisture to the air.
Ibuprofen: A non-steroidal anti-inflammatory drug (NSAID) commonly used to treat pain, swelling, and fever. Common brand names for Ibuprofen include Advil, Motrin, and Nuprin.
Infection: The growth of a parasitic organism within the body. (A parasitic organism is one that lives on or in another organism and draws its nourishment therefrom.) A person with an infection has another organism (a "germ") growing within him, drawing its nourishment from the person.
Influenza: The flu is caused by viruses that infect the respiratory tract which are divided into three types, designated A, B, and C. Most people who get the flu recover completely in 1 to 2 weeks, but some people develop serious and potentially life-threatening medical complications, such as pneumonia. Much of the illness and death caused by influenza can be prevented by annual influenza vaccination.
Kidney: One of a pair of organs located in the right and left side of the abdomen which clear "poisons" from the blood, regulate acid concentration and maintain water balance in the body by excreting urine. The kidneys are part of the urinary tract. The urine then passes through connecting tubes called "ureters" into the bladder. The bladder stores the urine until it is released during urination.
Larynx: The larynx is the portion of the breathing, or respiratory, tract containing the vocal cords which produce vocal sound. It is located between the pharynx and the trachea. The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck.
Lips: Aside from the lips of the mouth, there are two pairs of lips at the entrance to the vagina. They are the labia majora (the larger outside pair) and the labia minora (the smaller inside pair). Together they form part of the vulva (the female external genitalia).
Liver: An organ in the upper abdomen that aids in digestion and removes waste products and worn-out cells from the blood. The liver is the largest solid organ in the body. The liver weighs about three and a half pounds (1.6 kilograms). It measures about 8 inches (20 cm) horizontally (across) and 6.5 inches (17 cm) vertically (down) and is 4.5 inches (12 cm) thick.
Lungs: The lungs are a pair of breathing organs located with the chest which remove carbon dioxide from and bring oxygen to the blood. There is a right and left lung.
Medication: 1. A drug or medicine. 2. The administration of a drug or medicine. (Note that "medication" does not have the dangerous double meaning of "drug.")
Mouth: 1. The upper opening of the digestive tract, beginning with the lips and containing the teeth, gums, and tongue. Foodstuffs are broken down mechanically in the mouth by chewing and saliva is added as a lubricant. Saliva contains amylase, an enzyme that digests starch. 2. Any opening or aperture in the body. The mouth in both senses of the word is also called the os, the Latin word for an opening, or mouth. The o in os is pronounced as in hope. The genitive form of os is oris from which comes the word oral.
Mucus: A thick slippery fluid produced by the membranes lining certain organs such as the nose, mouth, throat, and vagina. Mucus is the Latin word for "a semifluid, slimy discharge from the nose." Note that mucus is a noun while the adjective is mucous.
Nasal: Having to do with the nose. Nasal drops are intended for the nose, not (for example) the eyes. The word "nasal" came from the Latin "nasus" meaning the nose or snout.
Nose: The external midline projection from the face.
Onset: In medicine, the first appearance of the signs or symptoms of an illness as, for example, the onset of rheumatoid arthritis . There is always an onset to a disease but never to the return to good health. The default setting is good health.
Pain: An unpleasant sensation that can range from mild, localized discomfort to agony. Pain has both physical and emotional components. The physical part of pain results from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it can be more diffuse, as in disorders like fibromyalgia . Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors.
Respiratory: Having to do with respiration, the exchange of oxygen and carbon dioxide. From the Latin re- (again) + spirare (to breathe) = to breathe again.
Respiratory system: The organs that are involved in breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs.
Salt: In medicine, salt usually refers to sodium chloride, table salt, used for seasoning food, for the preservation of meat, etc. Salt is found in the earth and in sea water and is isolated by evaporation and crystallization from sea water and other water impregnated with particles of salt.
Skin: The skin is the body's outer covering. It protects us against heat and light, injury, and infection. It regulates body temperature and stores water, fat, and vitamin D. Weighing about 6 pounds, the skin is the body's largest organ. It is made up of two main layers; the outer epidermis and the inner dermis.
Sore: 1. (adjective) A popular term for painful. I have sore fingers from typing dictionary terms. She has a sore throat . 2. (noun) A nondescript term for nearly any lesion of the skin or mucous membranes. He has a number of sores in his mouth.
Sore throat : Pain in the throat. Sore throat may be caused by many different causes, including inflammation of the larynx, pharynx, or tonsils.
Syndrome: A set of signs and symptoms that tend to occur together and which reflect the presence of a particular disease or an increased chance of developing a particular disease.
Syringe: A device used in medicine to inject fluid into or withdraw fluid from the body. Medical syringes consist of a needle attached to a hollow cylinder that is fitted with a sliding plunger. The downward movement of the plunger injects fluid; upward movement withdraws fluid.
Teaspoon: An old-fashioned but convenient household measure. A teaspoon holds about 5 cc of liquid.
Temperature: The temperature is the specific degree of hotness or coldness of the body. It is usually measured with a thermometer.
Throat: The throat is the anterior (front) portion of the neck beginning at the back of the mouth , consisting anatomically of the pharynx and larynx . The throat contains the trachea and a portion of the esophagus .
Tired: A feeling of a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a sense of weariness and fatigue.
Trachea: A tube-like portion of the breathing or "respiratory" tract that connects the "voice box" (larynx) with the bronchial parts of the lungs.
Tubes: The "tubes" are medically known as the Fallopian tubes. There are two Fallopian tubes, one on each side, which transport the egg from the ovary to the uterus (the womb). The Fallopian tubes have small hair-like projections called cilia on the cells of the lining.
See the entire definition of Tubes
Tylenol: See: Acetaminophen.
Viral: Of or pertaining to a virus. For example, "My daughter has a viral rash ."
Viral infection: Infection caused by the presence of a virus in the body. Depending on the virus and the person's state of health, various viruses can infect almost any type of body tissue, from the brain to the skin. Viral infections cannot be treated with antibiotics; in fact, in some cases the use of antibiotics makes the infection worse. The vast majority of human viral infections can be effectively fought by the body's own immune system, with a little help in the form of proper diet, hydration, and rest. As for the rest, treatment depends on the type and location of the virus, and may include anti-viral or other drugs.
Virus: A microorganism smaller than a bacteria, which cannot grow or reproduce apart from a living cell. A virus invades living cells and uses their chemical machinery to keep itself alive and to replicate itself. It may reproduce with fidelity or with errors (mutations)-this ability to mutate is responsible for the ability of some viruses to change slightly in each infected person, making treatment more difficult.
Viruses: Small living particles that can infect cells and change how the cells function. Infection with a virus can cause a person to develop symptoms. The disease and symptoms that are caused depend on the type of virus and the type of cells that are infected.
Voice box: The voice box, or larynx, is the portion of the respiratory (breathing) tract containing the vocal cords which produce sound. It is located between the pharynx and the trachea. The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck.
Windpipe: The trachea, a tube-like portion of the respiratory (breathing) tract that connects the larynx (the voicebox) with the bronchial parts of the lungs.
Ｑ：What is croup? What causes it?
Ａ：Croup is an infectious illness of the respiratory system involving the voice box and vocal cords (larynx), windpipe (trachea), and the airways leading to the lungs (bronchial tubes). It is usually caused by many different viruses, including those responsible for the common cold and influenza. Occasionally, it is caused by a bacterial infection. Croup can result in serious breathing difficulties in children. It is more common in babies over 6 months of age and young children, and it occurs more often in boys than girls. It tends to occur more often in the winter months when the weather is colder.
Ｑ：Is croup contagious?
Ａ：Croup is contagious, and it is usually spread by airborne infectious droplets sneezed or coughed into the air by infected children. When infectious droplets are inhaled by a healthy child, symptoms can develop in two to three days. The infection can also be spread by infected mucus deposited on doors, furniture, toys, and other objects. A healthy child can become infected by accidentally touching the infectious mucus and transferring the infection into his/her mouth.
Ｑ：What are the symptoms of croup?
Ａ：Approximately two or three days after being infected, the child notices increasing hoarseness and sore throat. A hacking "croupy" cough develops which sounds like a barking seal and becomes worse at night. Gagging and vomiting can occur with coughing. The cough is usually accompanied by a fever (100.4 to 104 degrees F; 38 to 40 degrees C). The infection causes swelling of the larynx and impairs air passage. A harsh crowing sound ("stridor") during inhaling can be heard when the child's air passage becomes abnormally narrowed. If this should occur, immediate evaluation by a physician is recommended. Even though most children with croup are cared for at home, those with breathing difficulties, high fever, or dehydration may need to be hospitalized. Infants with croup are grumpy, tired, and have poor appetites. The major part of the illness lasts for three days. A wet cough can continue for another two weeks. It is also possible to acquire the infection more than once.
Ｑ：What is the treatment for croup?
Ａ：Croup can be frightening for both children and parents. Therefore, comforting and reassuring the child is the first step. Breathing difficulties can develop and worsen rapidly. Close monitoring of the child is, therefore, important during the early phases of the illness.
To help the child breathe more comfortably, a cold or warm mist vaporizer or humidifier can be placed near the child. To avoid accidental burns, hot water vaporizers should be out of the reach of infants and toddlers. Also effective is having the child breathe in a bathroom steamed up with hot water from the tub or shower. When cough or stridor worsens at night, 10 or 15 minutes sitting or driving in the cool night air can also help the child breathe.
In infants and children, blockage in the nasal passages from mucus can further impair breathing. Careful instillation of saltwater nose drops (¼ teaspoon of table salt in one cup of water) into the nasal openings every few hours, followed by gentle suction using an ear bulb syringe, can be helpful in opening nasal passages.
Decongestants and cough suppressants can be helpful in relieving the congestion and hacking cough. However, the American Academy of Pediatrics recommends avoiding most combination cough and cold medicines especially if they contain dextromethorphan and diphenhydramine (Benadryl). Several studies show that these medicines are ineffective in children. They can potentially cause side effects that could lead to more serious symptoms. Before giving any over-the-counter cold medicine to your child, it is best to consult your health-care professional. Acetaminophen (Liquiprin, Tylenol, Panadol) and ibuprofen (Liquid Motrin, Advil) are also helpful for pain relief and fever. Aspirin is avoided in the treatment of croup and other viral illnesses since aspirin is suspected as being related to the Reye's syndrome in children recovering from influenza virus infection. Reye's syndrome is a serious and mysterious illness, causing kidney, liver, and brain damage, which can lead to the rapid onset of coma. Occasionally, cortisone medications are prescribed for more severe cases of croup. Because croup is usually caused by a virus, antibiotics are reserved for those rare occasions when bacterial infections cause croup or become superimposed on the viral infection.
Even though plenty of fluids are encouraged to avoid dehydration, forcing fluids is generally unnecessary. Popsicles are a popular means of providing fluid. Activity should be restricted to quiet play during the first days of the illness.
Children with croup are most contagious during the first days of fever and illness. Infection spreads easily in a household. Other children in the family will often develop a sore throat or a cough, without necessarily developing the croupy cough and stridor seen in croup. Infants and children may return to school or day care when their temperature is normal and they feel better. A lingering cough can last another two weeks but should not be the reason to keep them at home.
Ｑ：What warning signs should parents look for?
Ａ：The major concern in croup is the accompanying breathing difficulties as the air passages narrow. Close monitoring of the child's breathing is important. The child should be especially observed at night or when napping for breathing difficulty. The doctor should be notified if the child is having breathing difficulty, restlessness, fever over 103 degrees F, or if the parent feels frightened!
The breathing difficulty can progress rapidly, turning into a life-threatening emergency. Some children must be rushed by ambulance into the emergency room because of serious breathing difficulty. Signs of serious trouble include swallowing difficulty, nonstop drooling, bluish discoloration of the skin or lips, sucking in of the chest, and rapid breathing (over 80 breaths per minute).
While most children recover from croup without hospitalization, some children can develop life-threatening breathing difficulties. Therefore, close contact with the doctor during this illness is important.
Ｑ： Can my child get croup more than once?
Ａ： Yes. There are many viruses that can cause croup, including parainfluenza, adenovirus, respiratory syncytial virus (RSV), and influenza (the flu virus), and there are multiple subtypes of each virus, so your child can get croup multiple times as he gets infected with each of these viruses.
However, if your child is getting croup very often, then he may have spasmodic croup (acute spasmodic laryngitis), which can be triggered by viruses, allergies or reflux. Although they may have trouble breathing, children with spasmodic croup often don't have a fever, and get better quickly after several hours.
Ｑ： Is there a cure for croup?
Ａ： No. Like most viral respiratory tract infections in children, there is no cure.
Ｑ： Will antibiotics help children with croup?
Ａ： No. Unless your child has a secondary bacterial infection, such as an ear infection, antibiotics will not be effective against the viruses that cause croup.
Ｑ： How long does croup last?
Ａ： The main symptoms of croup typically last only 2-5 days, but more rarely, they can last several weeks. Once the barking cough and difficulty breathing improve, your child may continue to have cold symptoms for 7-10 days.
Ｑ： How can I prevent my child from getting croup?
Ａ： Although there is no vaccine (except for the flu vaccine) or medication that can prevent your child from getting croup, you can probably decrease the chance that your child will get croup by decreasing his exposure to other people that are sick. Also, strict handwashing and avoiding sharing foods and drinks can help to lessen your child's chances of getting sick.
Croup is a group of respiratory diseases that often affects infants and children under age 6. It is characterized by a barking cough; a whistling, obstructive sound (stridor) as the child breathes in; and hoarseness due to obstruction in the region of the larynx. It may be mild, moderate or severe, and severe cases, with breathing difficulty, can be fatal if not treated in a hospital. Another type of croup is known as spasmodic croup. People with spasmodic croup first catch a cold, rarely with fever, and then the croupy cough begins. In some cases spasmodic croup may begin suddenly without any preceding cold symptoms. Unlike viral croup, spasmodic croup usually recurs, can occur in older children, and rarely even in adults. Spasmodic croup is thought to be related to allergies.
Croup affects 5% of children in the second year of life; the peak incidence is 3 months to 3 years. The group of respiratory diseases consists of spasmodic croup, acute laryngotracheitis, laryngotracheobronchitis (LTB), laryngotracheobronchopneumitis (LTBP), and laryngeal diphtheria. LTB and LTBP, which usually involve a bacterial infection, are usually severe.
The first step in diagnosis is to exclude other acute obstructive illnesses in the region of the larynx, such as epiglottitis, a foreign body, or angioneurotic edema of the epiglottis. Misdiagnosing an obstructive airway disease can be fatal.
 Signs and symptoms
Croup is characterized by a harsh "barking" cough and sneeze, inspiratory stridor (a high-pitched sound heard on inhalation), nausea/vomiting, and fever. Hoarseness is usually present. More severe cases will have respiratory distress.
The "barking" cough (often described as seal-like) of croup is diagnostic. Stridor will be provoked or worsened by agitation or crying. If stridor is also heard when the child is calm, critical narrowing of the airway may be imminent.
In diagnosing croup, it is important for the physician to consider and exclude other causes of shortness of breath and stridor, such as foreign body aspiration and epiglottitis.
On a frontal X-ray of the cervical vertebrae, the steeple sign suggests the diagnosis of croup.
Croup is most often caused by parainfluenza virus, primarily types 1 and 2 (some definitions limit the term "croup" to this pathogen). However, other viral and possibly bacterial infections can also cause it. Approximately 75% of cases are caused by parainfluenza virus. Influenza A and B, Measles, adenovirus and (RSV) respiratory syncytial virus are other viruses that sometimes cause croup. It is most common in the fall and winter but can occur year-round, with a slight predilection for males.
The respiratory distress is caused by the inflammatory response to the infection, rather than by the infection itself. It usually occurs in young children as their airways are smaller and differently shaped than adults', making them more susceptible. There is some element of genetic predisposition as children in some families are more susceptible than others.
An entity known as spasmodic croup also occurs, distinct from the infectious variety, due to laryngeal spasms.
The treatment of croup depends on the severity of symptoms.
The Alberta Clinical Practice Guideline Working Group has developed guidelines for diagnosing and treating croup, including a scoring system for classifying severity. The severe form (which affected less than 1% of children seen in the emergency department) involves breathing difficulties, indicated by stridor, chest retractions, agitation and distress. Lethargy or decreased level of consciousness is a sign of impending respiratory failure, and requires emergency medical treatment. LTB and LTBP are usually severe, and require treatment in the intensive care unit, with a endotracheal (ET) tube to assist breathing, and antibiotics.
The routinely recommended treatment is with corticosteroids, although corticosteroids suppress the immune system and can predispose the child to infection. There is a debate over how many doses to give, but Cherry in the New England Journal of Medicine recommends one dose, and has observed that children with viral, bacterial and fungal complications have had multiple doses. Epinephrine produces a significant reduction in the croup severity score but the benefit only lasts for 2 hours. Children who have moderate or severe croup with blood oxygen saturation under 92% should receive oxygen.
Since laryngotracheitis is a viral disease (most commonly parainfluenza virus 1) antibiotics have no value.
Croup can be prevented by immunization for influenza and diphtheria. At one time, croup referred to a diphtherial disease, but with vaccination diphtheria is rare.
One of the traditional ways to treat croup is to inhale hot steam. However, studies have found that this is not effective. This was the sole treatment for croup throughout the nineteenth and most of the twentieth century. Hospitals today use a "blowby" apparatus for this purpose. Simpler remedies include taking the child outside in moist night air, or alternatively exposing the child to steam from a hot bath or a humidifier. There is little or no evidence to support their efficacy.
Mild croup with no stridor, or stridor only on agitation, and just a cough may simply be observed, or a dose of inhaled, oral, or injected steroids may be given. When steroids are given, dexamethasone is often used, due to its prolonged physiologic effects.
Moderate to severe croup may require nebulized adrenaline in addition to steroids. Oxygen may be needed if hypoxia develops. Children with moderate or severe croup are typically hospitalized for observation, usually for less than a day. Intubation is rarely needed (less than 1% of hospitalized patients).
Viral croup is a self-limited disease, but can very rarely result in death from complete airway obstruction. Symptoms may last up to 7 days, but typically peak around the second day of illness. Rarely, croup can be complicated by, (or confused with) an acute bacterial tracheitis, which is more dangerous.
Guideline for the Diagnosis and Management of Croup