Is Croup Contagious?
Croup is contagious. Symptoms of croup usually develop two to three days after exposure to viruses that cause the disease.
Croup is contagious. Symptoms of croup usually develop two to three days after exposure to viruses that cause the disease.
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 involvement of the larynx. Usually, croup is a viral infection and may be caused by many different viruses, including those responsible for the common cold and influenza. Rarely, it is caused by a bacterial infection.
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. Treatment varies depending on whether the child's illness is caused by a virus or a bacteria.
Viral croup can have two distinct presentations, both of which are a consequence of swelling of the vocal cords resulting in a narrowing of the airway. The more common variety has symptoms of fever (100 F-103 F), mild hoarseness, and sore throat two to three days after virus exposure. Quick to follow is the characteristic dry "barking seal" cough that may be associated with a harsh, raspy sound during inspiration. (This sound, called "stridor," has been noted to resemble the breathing of the Star Wars character Darth Vader.) The symptoms commonly last for four to seven days.
The alternative and less frequent presentation is called "acute spasmodic croup." These children will appear totally well when put to bed at night only to awaken their parents in the middle of the night with the above described barky cough and stridor. Fever and sore throat are not noted in these children, and the symptoms commonly resolve within eight to 10 hours from onset, and the child appears totally well until this same acute onset recurs the following night. This on/off pattern may occur over three to four nights in a row and then morph in to symptoms more characteristic of the common cold -- mucus-like nasal discharge and a "wet" cough for several days.
These two different presentations are the result of the particular virus that has infected the child. Manifestations of croup vary from mild (common) to life-threatening (rare). The severity of symptoms is proportional to the amount of relative narrowing of the airway. The more severe the vocal cord narrowing the more effort is required to inhale. A severely sick child will refuse to lie down, demanding to remain in an upright position. They will show retractions of the skin above the collarbone and between the ribs with inspiration and may develop facial cyanosis (bluish skin discoloration). Apparent exhaustion and decreased respiratory effort are an indication of impending respiratory failure and are cause for immediate paramedic evaluation and transport to the emergency department of the closest hospital.
In general, the duration of symptoms of croup is five to seven days. More severe croup may resolve in 14 days.
Teens and adults may develop an upper respiratory infection caused by the viruses which cause croup in younger children. However, since the internal diameter of the upper airway (larynx and trachea) is much larger than in younger children, the classsic barky cough, inspiratory stridor and respiratory distress is rare. More commonly, symptoms seen in a routine “cold” are the primary symptoms and signs.
Croup is contagious and is usually spread by airborne infectious droplets sneezed or coughed by infected children. When a healthy child inhales infectious droplets, 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.
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 high fever (> 103 F), sitting forward positioning, and excessive drooling. A 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 bacterial 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 deteriorate or not respond to routine therapy in the 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.
Rarely, a patient may have severe respiratory symptoms that need treatment with inhalation therapy with epinephrine (adrenaline) in the hospital where he or she can be monitored continuously. These therapies provide a temporary (two hour) reduction of symptoms, but is commonly followed by a return of equally severe symptoms. This reappearance of symptoms is commonly termed as a "rebound" phenomenon.
Side effects of epinephrine inhalation therapy include:
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.
The major concern in croup is the accompanying breathing difficulties as the upper airway narrows. 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 progressive breathing difficulty, unusual drooling, agitation or restlessness, fever over 103 F, or if the parent feels frightened.
The breathing difficulties seen in croup can progress rapidly, turning into a life-threatening emergency. On rare occasions, a child must be rushed by ambulance into the emergency room because of serious breathing problems. Signs of serious trouble include swallowing difficulty, nonstop drooling, bluish discoloration of the skin or lips (cyanosis), sucking in of the chest, and rapid breathing (over 60 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.
There is no current vaccination to prevent croup. However, several laboratories are working diligently to develop one. The infectious virus is most commonly transmitted by coughing or sneezing. Touching objects contaminated with infectious viral particles also allows transmission of the virus. Airborne viral particles can be infectious for about one hour. Virus on objects remains infectious for several hours. Avoiding these exposures can prevent croup.
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The safety of giving infants and children over-the-counter (OTC) cold and cough medicine is important for caregivers to understand. While there is no "gold standard" recommendation for giving infants and children OTC cold and cough medicine for fever, aches, cough, and runny nose, a few standards have been recommended.
The American Academy of Pediatrics recommends that OTC cold and cough medicine only be used in children age four years and older.
The American College of Chest Physicians recommend that these medicines only be used in children age 15 years and older.
The FDA recommends that OTC cold and cough medicine be used in children 2 years of age and older.
However, there is agreement in regard to which OTC medications should not be used in children under the age of four (or the age of two, depending upon which guidelines are used), and they are 1) certain antihistamines like brompheniramine, chlorpheniramine maleate, and diphenhydramine (Benadryl); 2) cough expectorants (guaifenesin); 3) cough suppressants (dextromethorphan, DM); and 4) decongestants (pseudoephedrine and phenylephrine).
Aspirin should never be given to infants, children, and adolescents due to the possibility of a rare, but often severe and even fatal illness called Reye's syndrome.
FDA. "Most Young Children with a Cough or Cold Don't Need Medicines." July 18, 2017.
FDA. "Use Caution When Giving Cough and Cold Products to Kids." Updated: Nov 04, 2016.
Coughing is a reflex that helps a person clear their airways of irritants. There are many causes of an excessive or severe cough including irritants like cigarette and secondhand smoke, pollution, air fresheners, medications like beta blockers and ACE inhibitors, the common cold, GERD, lung cancer, and heart disease.
Natural and home remedies to help cure and soothe a cough include stay hydrated, gargle saltwater, use cough drops or lozenges, use herbs and supplements like ginger, mint, licorice, and slippery elm, and don't smoke.
Over-the-counter products (OTC)to cure and soothe a cough include cough suppressants and expectorants, and anti-reflux drugs.
Prescription drugs that help cure a cough include narcotic medications, antibiotics, inhaled steroids, and anti-reflux drugs like proton pump inhibitors or PPIs, for example, omeprazole (Prilosec), rabeprazole (Aciphex), and pantoprazole (Protonix).
Laryngitis is an inflammation of the voice box (vocal cords). The most common cause of acute laryngitis is infection, which inflames the vocal cords. Symptoms may vary from degree of laryngitis and age of the person (laryngitis in infants and children is more commonly caused by croup). Common symptoms include
Chronic laryngitis generally lasts more than three weeks. Causes other than infection include smoking, excess coughing, GERD, and more. Treatment depends on the cause of laryngitis.
Sore throat (throat pain) usually is described as pain or discomfort in the throat area. A sore throat may be caused by bacterial infections, viral infections, toxins, irritants, trauma, or injury to the throat area. Common symptoms of a sore throat include a fever, cough, runny nose, hoarseness, earaches, sneezing, and body aches. Home remedies for a sore throat include warm soothing liquids and throat lozenges. OTC remedies for a sore throat include OTC pain relievers such as ibuprofen or acetaminophen. Antibiotics may be necessary for some cases of sore throat.