Croup is a common childhood ailment. Typically, it arises from a viral infection of the larynx (voice box) and is associated with mild upper respiratory symptoms such as a runny nose and cough. The key symptom is a harsh barking cough. Croup is usually not serious and most children recover within a few days. In a small percentage of cases, a child develops breathing difficulties andmay need medical attention.

At one time, the term croup was primarily associated with diphtheria, a life-threatening respiratory infection. Owing to widespread vaccinations, diphtheria has become rare in the United States, and croup currently refers to a mildviral infection of the larynx.

Parainfluenza viruses are the typical cause, but influenza (flu) and cold viruses may sometimes be responsible. All are highly contagious and easily transmitted via sneezing and coughing. Children between the ages of 3 months and 6years are usually affected, with the greatest incidence at one to two yearsof age. Croup can occur at any time of the year, but it is most typical during early autumn and winter. The characteristic harsh barking of a croupy coughcan be very distressing but rarely indicates a serious problem. Most children can be treated at home; however, 1-5% may require medical treatment.

Croup may sometimes be confused with more serious conditions, such as epiglottitis or bacterial tracheitis, which arise from bacterial infection and mustreceive medical treatment.

A croupy cough may be preceded by one to three days of symptoms that resemblea slight cold. It is often accompanied by a runny nose, hoarseness, and a low fever. When the child inhales, there may be a raspy or high-pitched noise,called stridor, owing to the narrowed airway and accumulated mucus. In this case, medical attention is required.

However, the airway rarely narrows so much that breathing is impeded. Symptoms usually disappear within a few days. Medical treatment may be sought if thechild's symptoms do not respond to home treatment.

Emergency medical treatment is required immediately if the child has difficulty breathing, swallowing, or talking; develops a high fever (103°F/39.4°C or more); seems not alert or confused; or has pale or blue-tinged skin.

Home treatment is the usual method of managing croup symptoms. It is important that the child is kept comfortable and calm as much as possible, because crying can make symptoms seem worse. Humid air can help a child with croup feelmore comfortable. Recommended methods include sitting in a steamy bathroom with the hot water running or using a cool-water vaporizer or humidifier. Breathing may also be eased by going outside into cooler air. The child should drink frequently in order to stay well hydrated. To treat any fever, the childmay be given an appropriate dose of acetaminophen (Tylenol). Antihistamines and decongestants are ineffective in treating croup. Children under 18 should not be given aspirin, as it may cause Reye's syndrome, a life-threatening disease of the brain.

If the child does not respond to home treatment, medical treatment at a doctor's office or emergency room could be necessary. An x ray of the throat areamay be done to assess the possibility of epiglottitis or other blockage of the airway. Based on severity of symptoms and response to treatment, the childmay need to be admitted to hospital. Of the 1-5% of children requiring medical treatment, approximately 1% need respiratory support. Such support involvesintubation (inserting a tube into the trachea) and oxygen administration.

Botanical/herbal medicines can help heal a croupy cough. Herbs to consider include aniseed (Pimpinella anisum), sundew (Drosera rotundifolia), thyme (Thymus vulgaris), and wild cherry bark (Prunus serotina). Homeopathic medicine can also be used to treat croup.

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