|Croup & Bronchiolitis|
Treat croup with humidity--a bath before bedtime, a cool mist vaporizer--and elevate the head of the bed.
Medicines for bronchiolitis are only effective in a few children. For the most part parents are stuck with supportive care--making sure the child gets adequate fluids, treating fever with Tylenol, and watching for signs that the baby may need to be evaluated
is a viral infection of the larynx (throat) &
sometimes trachea (main windpipe). Often it starts with a "croupy" or
junky cough which sounds like the child is trying the cough something up
out of his chest. At times the cough may sound like a dog barking or a
seal at the zoo. Usually the child is hoarse.
While fever is frequently present, high fever (>103) may suggest a different diagnosis & an emergent visit may be needed if the child seems ill or frightened.
Stridor is a noisy sound on inspiration [This is sometimes mistaken for wheezing which is louder with exhaling]. If the child has very noisy inspirations (stridor), he may also need to be seen on an emergent basis if there is difficulty breathing accompanying this stridor.
Although most croup is usually mild, severe croup can be life threatening.
Often the chest or abdomen will sink in on inspiration signifying the need to use additional muscles to bring air into the lungs & the need to be evaluated.
There are two types of croup: viral croup or viral laryngotracheobronchitis & spasmodic croup.
Viral croup usually progresses over several days with the initial symptoms being just a runny nose. Humidity in the form of a vaporizer, extra fluids, and the doctor frequently prescribes steroids to decrease the swelling of the airway in moderate cases. These are the mainstays of treatment along with observation for the signs that the child needs to be examined. Typically viral croup is a three to five day illness and antibiotics are not helpful in shortening the illness or preventing complications.
Acute spasmodic croup is a type of croup where a previously well or only mildly ill child awakens in the middle of the night severely short of breath with a barking cough and stridor. It can be frightening to both parent and child. Often these symptoms may quickly respond to cool night air or humidity in the form of a vaporizer or steaming up the bathroom. Spasmodic croup may resolve as quickly as it came on. It is not unusual for a worried family to jump in the car with a severely short of breath child only to arrive at the emergency department with a child who appears completely well. Hence try the humidity or the night air first. Recurrent acute spasmodic croup is often found in families that have allergies and asthma.
Not all croup needs treating. For the more ill child often the doctor will give an injection or prescribe steroids which decrease the swelling in the throat. Sometimes a few days into a croup like illness the cough may change and settle into the chest. The chest will then seem to rattle and the child may breathe faster. The cough starts to sound like something is being coughed loose or ""breaking loose."" At this point the child may be wheezing and bronchodilators like albuterol may be helpful.
Although the cough of croup may sound like it is coming from deep in the chest it is actually coming from around the vocal cords and main windpipe.
Croup is actually swelling of the main windpipe around the vocal cords. This is what gives the hoarseness. If there is enough swelling then a child will make a noise when he breathes in call stridor. Older children will often complain of sore throat. When asked instead of pointing to the back of the throat they will point to their neck.
Although most croup is a virus. On rare occasion an older child with a mycoplasma illness will present with croup.
is an acute viral lower respiratory
tract infection of children that usually occurs in the first two years of
RSV is the major cause of bronchiolitis especially in epidemics. Other causative infectious agents include influenza, Para influenza virus, adenovirus, rhinovirus and rarely mycoplasma pneumoniae. RSV can cause an acute respiratory illness in patients of any age. In infants and young children it is a common cause of bronchiolitis and occasionally pneumonia. In older children and adults, infection usually manifests as an upper respiratory tract illness (cold) and occasionally bronchitis. Reinfection throughout life is very common. Exacerbation of underlying conditions such as asthma or other chronic lung conditions is also common.
RSV is very contagious. If you have had a cold this time of year, more likely than not, you have had RSV. Humans are the only source of infection. Transmission of the virus is usually by direct or close contact with contaminated secretions or by droplets in the air. Spread among household and child care facilities (including adults) is common. The time when someone is most infectious is usually from 3 to 8 days, but it may be as long as 3 to 4 weeks. The incubation period (time from exposure to onset of symptoms)/less than 102F) and cough. Symptoms progress over a period of I to 7 days.
As bronchiolitis develops, the cough usually becomes more prominent (frequent choking, gagging cough) with or without increased work of breathing. The small child typically has very noisy breathing due to heavy nasal congestion or discharge. Parents of small children should contact their doctor if the child demonstrates any of the following general signs or symptoms--an emergency evaluation may be warranted.
Labored breathing which is manifested by nasal flaring, grunting, stridor (a loud nose when breathing in) or retractions (exaggerated rise and fall of the chest wall)
Persistent rapid breathing with wheezing or poor color
Poor oral intake or persistent vomiting after coughing episodes
Dry mouth or less than one wet diaper in 8 - 12 hours
Lethargy or listlessness
Fever greater than 100.5 in infants younger than two months of age
Excessive crying or irritability (many children have
Bronchiolitis has variable duration. Some children recover in 7-10 days, whereas others will cough for 3-4 weeks or even longer.
Physicians or parents canít interrupt the general progression of this virus, but we can recognize concerning signs and symptoms and provide close monitoring for complications, such as ear infections, dehydration and occasionally pneumonia.
Treatment of most infants and children with bronchiolitis is supportive care, including provision of adequate hydration and fever management. Parents should attempt to clear the infants nasal passages as frequently as needed to allow adequate feedings and sleep. It is important to encourage fluids including milk or formula if there is no vomiting. Elevation of the head of the crib and humidification of the air is sometimes helpful.
Since bronchiolitis is caused by a virus, antibiotics are not used, unless there is underlying bacterial component, such as ear infection; pneumonia; or possibly sinus infection if drainage and cough persist greater than 10-14 days. Sometimes medicine called bronchodilators (i.e. albuterol) are prescribed in an attempt to treat cough and wheezing depending on the childís age and symptoms. These are of limited benefit. Over the counter cough medicines, including cough suppressants and expectorants, have not proven beneficial in the treatment of bronchiolitis and are not recommended in young children.