Croup is an infectious pediatric illness of the respiratory system that involves predominantly the vocal cords (larynx) and windpipe (trachea) and to a lesser degree the upper airways of the lungs (bronchial tubes). The majority of a child’s symptoms reflect the involvement of the larynx. Usually, croup is a viral infection and may be caused by many different viruses, the most common virus that causes it is parainfluenza virus (types 1 and 2), apart from this other viruses that can cause it includes adenovirus, influenza virus A & B, metapneumovirus and respiratory syncytial virus; rarely, it is caused by a bacterial infection; the bacteria involved includes Staphylococcus aureus, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae.

Spasmodic Croup

This type is believed  to arise from allergies like from pollens or from reflux (in which the stomach contents back flow in the food pipe). It occurs all of sudden mostly in the middle of night. Fever doesn’t occur commonly in this type.

• Croup is more common and concerning in children between 6 months and 3 years of age, and rarely occurs in children over 6 years of age.
• Commonly, croup is seen from late fall through the early winter months.
• It has a slightly higher frequency in boys than in girls.
• Bacterial croup is an infection of the same structures that are affected during a viral process.
• Croup is contagious, especially during the first few days of the illness.
• Teens and adults can develop a respiratory infection from the viruses that are associated with what is traditionally considered croup in younger children. However, since the upper airway (trachea and larynx) in teens and adults are larger, the classic “bark” cough and “Darth Vader” sound (an abnormal, high-pitched sound while n inhaling).
• Spasmodic croup is a distinct type of croup infection. Initially, the child has no associated signs and symptoms of the infection, for example, fever, runny nose, or sore throat.

Classically, a healthy child with spasmodic croup is put to bed and awakens in the early morning with respiratory distress characterized by the barking cough and deep pitched sounds while inhaling. A child with spasmodic croup will have a moderately hoarse voice. Symptoms diminish and often by midday, the child is “back to normal,” only to regain the previous symptoms that evening. This pattern repeats for 3-4 nights.

The second phase of spasmodic croup (acute spasmodic croup) follows the above pattern in which the child’s symptoms morph into what resembles the common cold. This second and different wave of illness will often last 2-3 days as the child fully recovers.

Diet for croup watch in the end of this article

The major concern in croup is the accompanying breathing difficulties as the upper airway narrows. Close monitoring of the child’s breathing is important, especially at night or when napping for breathing difficulty. The doctor should be notified if the child is having progressive breathing difficulty, unusual drooling, agitation or restlessness, fever over 103 F.

The breathing difficulties seen in croup can progress rapidly, turning into a life-threatening emergency.

Signs of serious trouble include

• swallowing difficulty,
• nonstop drooling,
• bluish discoloration of the skin or lips (cyanosis),
• sucking in the chest, and
• rapid breathing (over 60 breaths per minute).

How long is croup contagious?

• Most viral causes of croup have an incubation period of 24-72 hours between exposure to the virus and the development of initial symptoms.
• Most children with viral croup are most contagious during the first days of fever and illness.
• The infection spreads easily in a household. Older children, teens, and adults in the family will often develop a sore throat or a cough, without necessarily developing the characteristic barky cough and stridor seen in croup.
• Infants and children may return to school or daycare 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.

The diagnosis of croup is most commonly made by obtaining the characteristic history of sudden-onset of hoarse voice, barky cough, stridor during inhalation, and the possibility of low-grade fever. While the child may appear rather ill, the child does not have a look of pure panic or terror. There can be a high fever (> 103 F), sitting forward positioning, and excessive drooling. Recent exposure to another child with croup helps to confirm the diagnosis.

Laboratory tests are rarely necessary and are mostly limited to severe situations where concern regarding a secondary infection may have developed and is superimposed upon the primary viral process. A particular X-ray orientation of the neck will often show a characteristic elongated narrowing of the region called a “steeple sign.” Such an X-ray finding is confirmatory for croup. Rarely will consultation with an otolaryngologist (ENT physician) be necessary to have a direct visual examination of the patient’s airway.

Such a procedure is termed fiberoptic laryngoscopy and is indicated if there is a concern for an anatomical malformation of the upper airway, possible aspiration of a foreign object, or should the child rapidly deteriorates or does not respond to routine therapy in an anticipated manner.

Most infants are routinely immunized against the bacteria Haemophilus influenzae type B (Hib). When the child is not immunized against Hib, the possibility of a more ominous, deep bacterial infection called epiglottitis exists.

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 important during the early phases of the illness.

• To help the child breathe more comfortably, a cool or warm mist vaporizer can be placed near the child. The humidified air promotes the reduction of vocal cord swelling and thus lessens symptoms. 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, 10-15 minutes of sitting or driving in the cool night air can also help relieve the child’s respiratory symptoms.
• In infants and children, blockage in the nasal passages from mucus can further impair breathing. Careful instillation of saline nasal drops/spray into the nasal openings every few hours. For small kids followed by gentle suction using a bulb syringe, can be helpful in opening nasal passages.
• Avoid common combination cough and cold allopathic drugs. Several studies show that these allopathic drugs are ineffective in children. They can potentially cause side effects that could lead to more serious symptoms.
• Aspirin is avoided in the treatment of croup and other viral illnesses since aspirin is suspected as being related to Reye’s syndrome. Reye’s syndrome is a serious illness that causes kidney, liver, and brain damage, which can lead to the rapid onset of coma.
• Occasionally, an oral cortisone medication (dexamethasone) is prescribed for more severe cases of croup.

Rarely, a patient may have severe respiratory symptoms that need treatment with inhalation therapy with epinephrine (adrenaline) in the hospital where the patient can be monitored continuously. These therapies provide a temporary (two-hour) reduction of symptoms but are commonly followed by a return of equally severe symptoms. This reappearance of symptoms is commonly termed a “rebound” phenomenon.

Side effects of epinephrine inhalation therapy include:

• Rapid heart rate
• Elevation of blood pressure
• Nausea
• Occasionally vomiting and agitation.

Because a virus usually causes croup, 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.

Homeopathic Treatment of croup

Ambra Gresia

Asthmatic breathing with eructation of gas. Nervous, spasmodic cough, with hoarseness and eructation, on waking in morning; worse in presence of people. Tickling in throat, larynx and trachea, chest oppressed, gets out of breath when coughing. Hollow, spasmodic, barking cough, coming from deep in chest. Choking when hawking up phlegm. Palpitation, with pressure in chest as from a lump lodged there, Palpitation in open air with pale face.

Kalium Bichromicum

Voice hoarse; worse, evening. Metallic, hacking cough. Profuse, yellow expectoration, very glutinous and sticky, coming out in long, stringy, and very tenacious mass. Tickling in larynx. Catarrhal laryngitis cough has a brassy sound. True membranous croup, extending to larynx and nares. Cough, with pain in sternum, extending to shoulders; worse when undressing. Pain at bifurcation of trachea on coughing; from mid-sternum to back.

Drosera Rotundfolia

Affects markedly the respiratory organs and is the principal remedy for whooping-cough. Drosera can break down resistance to tubercle. Phthisis pulmonal; vomiting of food from coughing with gastric irritation and profuse expectoration. Spasmodic, dry irritative cough, whooping cough. yellow expectoration, with bleeding from nose and mouth, laryngitis. Rough, scraping sensation deep in the faucet and soft palate.

Causticum

Hoarseness with pain in chest; aphonia. Larynx sore. Cough, with raw soreness of chest. Expectoration scanty; must be swallowed. Cough with pain in hip, especially left worse in evening; better, drinking cold water; worse, warmth of bed. Sore streak down trachea. Mucus under sternum, which he cannot quite reach. Pain in chest, with palpitation. Cannot lie down at night. Voice re-echoes. Own voice roars in ears and distresses. Difficulty of voice of singers and public speakers.

Sambucus Nigra

Chest oppressed with pressure in stomach, and nausea Hoarseness with tenacious mucus in larynx. Paroxysmal, suffocative cough, coming on about midnight, with crying and dyspnea. Spasmodic croup. Dry coryza. Sniffles of infants; nose dry and obstructed. Loose choking cough. When nursing child must let go of nipple, nose blocked up, cannot breathe. Child awakes suddenly, nearly suffocating, sits up, turns blue. Cannot expire. Millar’s asthma.

Dry heat while sleeping. Dreads uncovering. Profuse sweat over entire body during waking hours. Dry, deep cough precedes the fever paroxysm.

Pulsatilla Pratensis

Capricious hoarseness; comes and goes. Dry cough in evening and at night; must sit up in bed to get relief; and loose cough in the morning, with copious mucous expectoration. Pressure upon the chest and soreness. Great soreness of epigastrium. Urine emitted with cough. Pain as from ulcer in middle of chest. Expectoration bland, thick, bitter, greenish. Short breath, anxiety, and palpitation when lying on left side. Smothering sensation on lying down.

Conium Maculate

Dry hacking cough, almost continuous; worse, evening and at night, when lying down, talking or laughing, and during pregnancy. Expectoration only after long coughing.

The patient has a cough at night on lying down. They are restless at night and tend to sit up many times due to coughing spells. A tickling sensation in the throat pit may be prominently present. A few individuals may complain of an unusually dry spot in the larynx. In some cases, a headache on coughing may arise.

Hydrocyanicum Acidum

Noisy and agitated breathing. Dry, spasmodic, suffocative cough. Asthma, with contraction of throat. Whooping-cough. Paralysis of lungs. Marked cyanosis; venously congested lung.

Cina Maritima

Gagging cough in the morning. Whooping-cough. Violent recurring paroxysms, as of down in throat. Cough ends in a spasm. Cough so violent as to bring tears and sternal pains; feels as if something had been torn off. Periodic; returning spring and fall. Swallows after coughing. Gurgling from throat to stomach after coughing. Child is afraid to speak or move for fear of bringing on paroxysm of coughing. After coughing, moaning, anxious, gasps for air and turns pale.

Light chill. Much fever, associated with clean tongue. Much hunger; colicky pains; chilliness, with thirst. Cold sweat on forehead, nose, and hands.

Spongia Tosta

A remedy especially marked in the symptoms of the respiratory organs, cough, croup, thyroid gland swollen. stitches and dryness in throat, burning stinging and sore throat etc. Tickling causes cough. Clears throat constantly. Laryngeal phthisis. Goiter.

Great dryness of all air-passages. Hoarseness; larynx dry, burns, constricted. Cough, dry, barking, croupy; larynx sensitive to touch. Croup; worse, during inspiration and before midnight. Respiration short, panting, difficult; feeling of a plug in larynx. Cough abates after eating or drinking, especially warm drinks. Wheezing asthmatic cough, worse cold air and lying, head low and in warm, with profuse expectoration and suffocation. Oppression and heat of chest.

Swelling and induration of glands; also exophthalmic; cervical glands swollen with tensive pain on turning head, painful on pressure; Goiter. Itching; measles.

Corallium Rubrum

whooping and spasmodic coughs, especially when the attack comes on with a very rapid cough, and the attacks follow so closely as to almost run into each other. Often preceded by sensation of smothering, followed by exhaustion. Profuse, nasal catarrh. Cough that results from PND (post nasal dripping). Hawking of profuse mucus. Throat very sensitive, especially to air.

The cough appears in quick, short attacks that follow each other in quick succession, hysterical cough. Dry, spasmodic, suffocative cough; very rapid cough, short, barking, whooping-cough. Extreme exhaustion is felt along with the cough. A vital symptom that attends the above symptoms are extremely sensitive air passages to air (inhaled air feels cold).

Millifolium

Millifolium is an antiviral medicine. Cough with bloody sputa or in any lung disease with accompanying cough. Shortness of breath, difficulty in breathing, oppression of chest. Hemoptysis after injury or following violent exertion.

Pulsatilla Nigricans

Capricious hoarseness. Dry cough in evening and at night; must sit up in bed to get relief; and loose cough in the morning, with copious mucous expectoration. Expectoration bland, thick, bitter, greenish. Short breath, anxiety, and palpitation when lying on left side.

Phosphorus

Cough from tickling in throat; worse, cold air, reading, laughing, talking, from going from warm room into cold air. Sweetish taste while coughing. Hard, dry, tight, racking cough. Congestion of lungs. Burning pains, frothy or blood-stained sputum. The phlegm may be salty or sweet to taste. Strong odors may trigger a cough. Pneumonia, with oppression.

Bryonia Alba

Soreness in larynx and trachea. Hoarseness; worse in open air. Dry, hacking cough from irritation in upper trachea. Cough, dry, at night; must sit up; worse after eating or drinking, with vomiting, with stitches in chest, and expectoration of rust-colored sputa. Frequent desire to take a long breath; must expand lungs. Difficult, quick respiration; worse every movement; caused by stitches in chest. Cough, with feeling as if chest would fly to pieces; presses his head on sternum; must support chest. Croupous and pleuro-pneumonia. Expectoration brick shade, tough, and falls like lumps of jelly. Tough mucus in trachea, loosened only with much hawking. Coming into warm room excites cough. Heaviness beneath the sternum extending towards the right shoulder. Cough worse by going into warm room.

Throat: Dryness, sticking on swallowing, scraped and constricted. Tough mucus in larynx and trachea, loosened only after much hawking; worse coming into warm room.

Sambucus Nigra

Hoarseness with tenacious mucus in larynx. Paroxysmal, suffocative cough, coming on about midnight, with crying and dyspnea. Spasmodic croup. Dry coryza. Sniffles of infants; nose dry and obstructed. Loose choking cough. When nursing child must let go of nipple, nose blocked up, cannot breathe. Child awakes suddenly, nearly suffocating, sits up, turns blue. Cannot expire. Millar’s asthma.

Moschus

Tightness of chest, is obliged to take a deeper breath. Sudden constriction of larynx and trachea. Difficult respiration; chest oppressed; hysterical spasm of chest; asthma. Spasm of glottis. Impending paralysis of lungs. Asthma, with intense anxiety, fear, and smothering sensation. Cough ceases, mucus cannot be expectorated. Globus hystericus.

Mephitis Putorius

Sudden contraction of glottis, when drinking or talking. Food goes down wrong way. False croup; cannot exhale. Spasmodic and whooping-cough. Few paroxysms in day-time, but many at night; with vomiting after eating. Asthma, as if inhaling Sulphur; cough from talking; hollow, deep, with rawness, hoarseness, and pains through chest. Violent spasmodic cough; worse at night.

Senega

Hoarseness. Hurts to talk. Bursting pain in back on coughing. Catarrh of larynx. Loss of voice. Hacking cough. Thorax feels too narrow. Cough often ends in a sneeze. Rattling in chest. Chest oppressed on ascending. Bronchial catarrh, with sore chest walls; much mucus; sensation of oppression and weight of chest. Difficult raising of tough, profuse mucus, in the aged. Asthenic bronchitis of old people with chronic interstitial nephritis or chronic emphysema. Old asthmatics with congestive attacks. Exudations in Pleura. Hydrothorax. Pressure on chest as though lungs were forced back to spine. Voice unsteady, vocal cords partially paralyzed.

Throat: Catarrhal inflammation of throat and faucets, with scraping hoarseness. Burning and rawness. Sensation as if membrane had been abraded.

Mercurius Sulphuricus

Throat. Heat and sensation of constriction in throat. Dryness of tongue and throat. Burning in mouth and throat. Respiratory Organs. Roughness in throat and hoarseness. Sensation of heat in larynx. Increased expectoration of mucus from larynx” and trachea. Dyspnea; in children; hydrothorax.

Coccus Cacti

Constant hawking from enlarged uvula; coryza, with inflamed faucets; accumulation of thick viscid mucus, which is expectorated with great difficulty. Tickling in larynx. Sensation of a crumb behind larynx, must swallow continually; brushing teeth causes cough. Faucets very sensitive. Suffocative cough; worse, first waking, with tough, white mucus, which strangles. Spasmodic morning cough. Whooping cough attacks end with vomiting of this tough mucus. Chronic bronchitis complicated with gravel; large quantities of aluminous, tenacious mucus, are expectorated. Walking against wind takes breath away.

Bromium

Whooping cough (Use persistently for about ten days). Dry cough, with hoarseness and burning pain behind sternum. Spasmodic cough, with rattling of mucus in the larynx; suffocative. Hoarseness. Croup after febrile symptoms have subsided. Difficult and painful breathing. Violent cramping of chest. Chest pains run upward. Cold sensation when inspiring. Every inspiration provokes cough. Laryngeal diphtheria, membrane begins in larynx and spreads upward. Spasmodic constriction. Asthma; difficulty in getting air into lung. Better at sea, of seafaring men when they come on land. Hypertrophy of heart from gymnastics. Fibrinous bronchitis, great dyspnea. Bronchial tubes feel filled with smoke.

Nux Vomica

Catarrhal hoarseness, with scraping in throat. Spasmodic constriction. Asthma, with fullness in stomach, morning or after eating. Cough, with sensation as if something were torn loose in chest. Shallow respiration. Oppressed breathing. Tight, dry hacking cough; at times with bloody expectoration. Cough brings on bursting headache and bruised pain in epigastric region.

Throat: Rough, scraped feeling. Tickling after waking in morning. Sensation of roughness, tightness, and tension. Pharynx constricted. Uvula swollen. Stitches into ear.

Rumex Crispus

Nose dry. Tickling in throat-pit causes cough. Copious mucous discharge from nose and trachea. Dry, teasing cough, preventing sleep. Aggravated by pressure, talking, and especially by inspiring cool air and at night. Thin, watery, frothy expectoration by the mouthful: later, stringy and tough. Rawness of larynx and trachea. Soreness behind sternum, especially left side, in region of left shoulder. Raw pain under clavicle. Lump in throat.

Dulcamara

Cough worse cold, wet weather, with free expectoration, tickling in larynx. Cough, hoarse, spasmodic. Whooping-cough, with excessive secretion of mucus. Winter coughs, dry, teasing. Asthma with dyspnoea. Loose, rattling cough; worse wet weather. Must cough a long time to expel phlegm. Cough after physical exertion.

Dry coryza. Complete stoppage of nose. Stuffs up when there is a cold rain. Thick, yellow mucus, bloody crusts. Profuse coryza. Wants nose kept warm, least cold air stops the nose. Coryza of the new born.

Belladonna

Drying in nose, faucet, larynx, and trachea. Tickling, short, dry cough; worse at night. Larynx feels sore. Respiration oppressed, quick, unequal. Cheyne-Stokes respiration. Hoarse; loss of voice. Painless hoarseness. Cough with pain in left hip. Barking cough, whooping cough, with pain in stomach before attack, with expectoration of blood. Stitches in chest when coughing. Larynx very painful; feels as if a foreign body were in it, with cough. High, piping voice. Moaning at every breath.

Throat dry, as if glazed; angry-looking congestion; red, worse on right side. Tonsils enlarged; throat feels constricted; difficult deglutition; worse, liquids. Sensation of a lump. Esophagus dry; feels contracted. Spasms in throat. Continual inclination to swallow. Scraping sensation. Muscles of deglutition very sensitive. Hypertrophy of mucous membrane.

Chamomilla

Hoarseness, hawking, rawness of larynx. Irritable, dry, tickling cough; suffocative tightness of chest, with bitter expectoration in daytime. Rattling of mucus in child’s chest. Parotid and submaxillary glands swollen. Constriction and pain.

Ferrum Phosphoricum

First stage of all inflammatory affections. Congestions of lungs. Hemoptysis. Short, painful tickling cough. Croup. Hard, dry cough, with sore chest. Hoarseness. Expectoration of pure blood in pneumonia. Cough better at night.

Mouth hot; faucets red, inflamed. Ulcerated sore throat. Tonsils red and swollen. Eustachian tubes inflamed. Sore throat of singers. Subacute laryngitis with faucet inflamed and red (2x). After operations on throat and nose to control bleeding and relieve soreness. First stage of diphtheria. Ranula in vascular, sanguine constitutions.

Hepper Sulphuricum

When swallowing, sensation as if a plug and of a splinter in throat. Quinsy, with impending suppuration. Stitches in throat extending to the ear when swallowing. Hawking up of mucus. Hoarseness, with loss of voice. Cough troublesome when walking. Dry, hoarse cough. Croup with loose, rattling cough; worse in morning. Choking cough. Rattling, croaking cough; suffocative attacks; has to rise up and bend head backwards. Anxious, wheezing, moist breathing, asthma worse in dry cold air; better in damp. Palpitation of heart.

Cuprum Metallicum

Cough as a gurgling sound, better by drinking cold water. Suffocative attacks, worse 3 am (Am c). Spasm and constriction of chest; spasmodic asthma, alternating with spasmodic vomiting. Whooping-cough, better, swallow water, with vomiting and spasms and purple face. Spasm of the glottis. Dyspnea with epigastric uneasiness. Spasmodic dyspnea before menstruation. Angina with asthmatic symptoms and cramps.

Ipecacuanha

Dyspnea; constant constriction in chest. Asthma. Yearly attacks of difficult shortness of breathing. Continued sneezing; coryza; wheezing cough. Cough incessant and violent, with every breath. Chest seems full of phlegm, but does not yield to coughing. Bubbling rales. Suffocative cough; child becomes stiff, and blue in the face. Whooping-cough, with nosebleed, and from mouth. Bleeding from lungs, with nausea; feeling of constriction; rattling cough. Croup. Hemoptysis from slightest exertion. Hoarseness, especially at end of a cold. Complete aphonia.

• The prognosis for a child who develops croup is excellent, especially if treated with Homeopathy.
• Most cases of croup can be managed at home by exposing the child to cool moist air.

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