What is croup cough? Croup is a respiratory condition that
results in swelling of airways, usually due to a viral infection, and a
harsh barking croup cough. It is most common among children 1 to 5 years old
and rarely happens in adults and teenagers since they have larger airways.
The infection accompanied by croup is usually contagious. Hand-washing, strictly nose breathing (to prevent infections entering
through the mouth), and other hygienic precautions are crucial for health of
the household members. For mouth breathing effects, visit
Mouth breathing problems.
Cause of croup cough
In most cases,
croup cough is caused by alveolar hyperventilation (breathing more air than the
medical norm) that leads to hypocapnia
(deficiency of CO2 or carbon dioxide). Hypocapnia causes constriction of airways,
promotes chronic inflammation, and irritable state of nerve cells leading to
chronic expression of the urge-to-cough reflex. Other effects of alveolar hypocapnia
are reduced body-oxygen content, production of free radicals in hypoxic
cells, and the
suppressed immune system due to tissue hypoxia. The dysfunctional immune
system cannot prevent infections and, superficially, infections look
like the cause of croup, but in reality chronic hyperventilation is the
cause of croup cough.
Treatment of croup cough
Most cases of croup cough do not require ER (Emergency Room) treatment.
However, if your child’s breathing gets even heavier, severe
hyperventilation will cause: skin retractions (observe the skin between
the ribs pulls in with each inhalation), a fatigued and very sick
appearance, difficulty swallowing, drooling, stridor (squeaking sounds
when inhaling), a color around the mouth, and symptoms of dehydration.
Pay attention to all these signs in kids. They indicate that the situation gets more
While leading health care providers continue to claim that use of
humidified air is useful in management of croup cough, there is no medical
evidence to support humidified air inhalation (Moore & Little, 2007; Wright
et al, 2005; Lebecque, 1999). However, some parents and doctors still report
that they get benefits from breathing steam from a hot bath (with or without
essential oils) during croup cough attacks.
Clinical experience of medical doctors practicing breathing retraining
have found that it is possible to reduce duration and severity of
cough and infections. (Normally, these viral infections lasts for 3-5 days.). Step No. 1 is to teach a child,
if possible, how to cough only
through the nose to prevent CO2 losses and boost the immune system. Next, this simple breathing exercise
how to stop a
cough in adults will help children too. The exercise should be practiced
by adults and then taught to children. It also helps kids to fall asleep faster.
YouTube Video: How to
Cure a Cough.
Moore M, Little P, Humidified air inhalation for treating croup: a
systematic review and meta-analysis, Fam Pract. 2007 Sep;24(4):295-301.
Epub 2007 Jun 29.
BACKGROUND: Croup (laryngotracheobronchitis) is a common cause of upper
airway obstruction in children. Treatment with humidified air was previously
widely used and is still commonly recommended as home treatment.
OBJECTIVE: To assess the efficacy of humidified air in the treatment of
DESIGN: Systematic review and meta-analysis.
DATA SOURCES: We searched the Cochrane Central Register of Controlled
Trials, MEDLINE and EMBASE.
REVIEW METHODS: We included randomized controlled trials with or without
blinding. All studies treating children with a clinical diagnosis of croup
with warm or cool humidified air delivered by steam or humidified tent
whether inpatients, attendees at the Emergency Department or in the
community were eligible.
MAIN RESULTS: Three studies in emergency settings provided data on 135
patients with moderate croup for the main outcome (croup score). The
combined results from 20 to 60 minutes in the three studies marginally
favored the treatment group with a weighted standardized mean difference of
-0.14 (95% confidence interval = -0.75 to 0.47). No outcomes were
significantly different between the groups.
CONCLUSIONS: The croup score of children managed in an emergency setting
with mild to moderate croup probably does not improve greatly with
inhalation of humidified air. There is insufficient evidence to exclude
either a small beneficial or a harmful effect.
Wright RB, Rowe BH, Arent RJ, Klassen TP, Current pharmacological options in
the treatment of croup, Expert Opin Pharmacother. 2005 Feb;6(2):255-61.
Department of Pediatrics, Pediatric Emergency Medicine, 2C3, 8440-112
Street, Edmonton, Alberta, Canada. BWright@cha.ab.ca
Croup is one of the most common respiratory illnesses seen in the acute
pediatric setting. It can be a cause of acute stridor and/or respiratory
distress in young children. Research has shown that therapy aimed at
reducing symptoms and inflammation can reduce complications such as the need
for intubation, hospitalization and improve quality of life for parents and
children. Corticosteroids are the primary treatment option that will
accomplish both goals and can be used in out-patient and in-patient
settings. Corticosteroids may be given orally, parenterally or in wet
nebulised form; however, oral administration is the preferred route. Wet
nebulised adrenaline (racaemic or l-adrenaline) is also an effective
treatment for more severe cases of croup. Recent studies have shown that
mist/humidified air provides no additional symptom improvement, nor does it
alter the overall cause of the disease process. Currently, there is
insufficient randomised controlled trial evidence to support the role of
heliox in the short-term treatment of croup.
Lebecque P, Childhood croup [Article in French], Arch Pediatr. 1999
Clinique Saint-Luc, université de Louvain, Bruxelles, Belgique.
Hoarseness, whooping cough and stridor are elements of a syndrome of upper
airway obstruction. In childhood, acute laryngotracheobronchitis is by far
the commonest cause of this syndrome. Yet, the differential diagnosis
includes a number of rare and severe entities. In many cases, the
traditional distinction between viral and spasmodic types is not possible.
The value of humidifying therapy has not been established. In severe
cases, nebulized adrenaline is of benefit but should be reserved for
hospital. The effect lasts only two hours and at times a rebound effect is
observed. It is now realized that some patients treated with adrenaline can
safely be discharged after a two to three hours observation. There is a
large body of evidence that all children arriving at the emergency
department with croup should receive steroids without delay. This policy
results in a much better outcome, with important reduction in
hospitalizations, intensive care unit admissions and incubations. Oral
dexamethasone is the drug of choice: it is as effective, easier to
administer and cheaper than nebulised budesonide. In most studies,
dexamethasone has been used at a dose of 0.6 mg/kg but there is some
evidence that 0.15 mg/kg may be just as effective.