How long does it take to treat croup in children? False croup in children: symptoms and treatment. What types of croup are there?

Preschool children often suffer from serious illnesses that can cause serious harm baby's health. One of these dangerous diseases is false croup. This disease is dangerous because it causes swelling and spasms in the child, making breathing difficult and causing suffocation.

Symptoms of false croup in children

With false croup, a narrowing of the child's larynx develops. It occurs due to swelling or spasm muscle tissue. Typically, the cause of this condition is considered to be a peculiarity of the child’s respiratory organs. In the preschool period, children have a significant amount of blood vessels And . This makes the larynx more vulnerable. The situation is further aggravated by the funnel-shaped shape of the trachea and bronchi, which allows microbes to be localized at one point.

Most often, the attack develops unexpectedly in the evening or at night. The child begins to have a barking or croaking cough. Then the baby becomes hoarse voice or it may disappear altogether. The child begins to breathe noisily and frequently.

Such difficulty breathing inevitably affects the functioning of the heart. His work becomes more frequent, the skin becomes pale, dark shadows lie near the eyes, and blueness appears along the line of the nasolabial folds.

If the child suffers from an infectious disease, his temperature may rise. If false croup is caused by an allergy, then the child’s skin becomes covered with rashes accompanied by itching. In the future, suffocation may develop. This state of affairs cannot be allowed to happen.

Treatment of false croup in children

If a child has developed swelling and spasm of the larynx of the first or second degree, then treatment is carried out in a hospital in the infectious diseases department. With a higher degree of stenosis, the baby is hospitalized in the intensive care unit.

The process of treating this disease consists of solving three problems - it is necessary to prevent the occurrence of new attacks, cure inflammation and eliminate swelling. Treatment must be prescribed by a doctor; independent actions can only provoke deterioration and generally lead to the most dangerous consequences.

The main measures taken are:

Regular influx fresh air, and therefore the room needs to be ventilated periodically. If the air is too dry, it makes sense to use humidifiers.
The child needs to be given water alkaline drinking, which significantly speeds up the process of sputum separation.
The child should not be fed food that is too hard and irritates the surface of the throat.
To soften the surface of the throat, give your child lozenges, use inhalers and aerosols.
To relieve swelling, give your baby the medications prescribed by your doctor. antihistamines. This will relieve swelling faster and make it easier for the child to cough up.
With severe laryngeal stenosis, it is necessary to give the baby glucocorticoid medications and anti-inflammatory drugs prescribed by the doctor.
If your baby has a bacterial or fungal infection, be sure to use antifungal and antibacterial medications prescribed by your doctor.

If conservative treatment does not bring results, then tracheostomy and intubation are performed. In most cases, false croup is cured well. Respiratory blockage is rare. With this disease, the peak occurs on the second day of the disease, and within a week the clinical picture can be monitored.

First aid for false croup

Since with false croup it develops swelling of the larynx threatening the life of a child, it is very important to provide first aid to the baby in a timely manner.

The sequence of actions should be like this:

Be sure to call an ambulance immediately.
While you wait for the specialists to arrive, reassure your child. After all, his nervous condition and crying only increase the intensity of the cough.
Place your baby in the bed so that his upper body is higher. To do this, place a couple of pillows under the child's head and back.
Prepare a warm drink - soda solution concentration 2% or warmed milk mixed with mineral water. These products help dissolve mucus and perfectly moisturize the mucous membranes of the throat.
Using a nebulizer, if possible, inhale with mineral water. You can use saline solution instead of mineral water.
In the room where it lies, open the window. The child will need moist air, so use a humidifier or hang it around the room wet towels. Humidified cold air will help relieve swelling of the larynx.
If possible, the baby can be wrapped in a warm blanket and taken out to the balcony.
You can instill a vasoconstrictor drug. Inhalation of this drug through a nebulizer will also work well.
If your child's age allows, give him an antihistamine that will reduce laryngeal swelling. To relieve spasms, it is permissible to give the child No-Spa. If your baby has a fever, give him some antipyretics.

At the same time, you need to know about those actions that you absolutely cannot do:

Without appropriate doctor's advice, you should not give your baby cough suppressants.
Do not rub or place mustard plasters.
Do not inhale using home-made inhalers.
Do not feed your child foods that can cause... These include all citrus fruits, raspberry jam and honey.

False croup is a disease that most often affects children, and it manifests itself with many signs that are quite easily confused with other ailments. The consequences of the disease can be quite complex, so parents should remember that a lot depends on them - timely contact with a doctor will help to begin treatment immediately. How does false croup manifest itself in children, symptoms and treatment of this dangerous disease, features and unpleasant consequences– it’s better to study everything in advance so as not to be caught off guard.

Symptoms of false croup that should prompt immediate medical attention

Questions that parents often have are what false croup is in children, the symptoms and treatment of this disease, how dangerous it is for the child and whether it will cause irreversible processes in the small body. The first thing you need to know is that this disease is quite serious, and if left untreated, it can lead to dangerous consequences for the baby’s health. That is why it is so important to start treatment as early as possible - the chances of a successful recovery increase several times.

Symptoms of the disease that parents should pay attention to:

night coughing attacks accompanied by shortness of breath, difficulty breathing;
sputum is practically not coughed up, which often leads to injury respiratory tract, in the scanty secreted mucus you can see blood inclusions;
hoarseness of voice appears;
often coughing attacks turn into severe vomiting;
the child’s skin turns pale, fingertips and lips acquire a threatening blue tint;
temperature rises;
the baby is worried about a runny nose, severe pain in the throat.

Already the first signs of the disease should be a reason to go to the doctor - it is strictly not recommended to start treatment on your own.

Treatment of false croup in children with pharmaceutical drugs

It is better to learn about how false croup develops in children, the symptoms and treatment of the disease, and what the risk may be for the baby from a doctor, who should be contacted at the first signs of the disease. In the presence of complications, treatment should be carried out only in medical institution, under the supervision of specialists. Usually a complex effect on the disease is prescribed - a combination of several drugs.

Treatment of false croup in children is carried out with the following formulations:

Suprastin, Tavegil (antihistamines);
inhalations with naphthyzine to constrict blood vessels;
diuretics;
Pulmicort (hormonal medicine);
Algirem, Arbidol (antibacterial drugs).

To quickly remove mucus and reduce the intensity of cough attacks, it is likely that the doctor will prescribe antitussive drugs - Ambrobene, Lazolvan. Regardless of which particular drug was prescribed, the dosage, duration of treatment and number of doses per day are determined only by the doctor. It is strictly not recommended to independently increase or decrease intake or replace medications with analogues.

False croup, treatment at home

If a doctor diagnoses false croup during examination, treatment at home should only begin with his permission, in the complete absence of complications. Typically used here pharmaceutical drugs or herbal compositions against cough, which is the main sign of the disease and brings the baby the most suffering.

To treat a cough, you can use pharmaceutical compositions, but you can successfully cope with the disease with gentle traditional methods. For these purposes, you can use a milk-based product that actively causes expectoration. If the last dose of the composition is taken just before bedtime, the child will sleep peacefully throughout the night, without debilitating anxiety attacks.

Preparation:

Bring milk to a boil (200-220 ml).
Remove from the stove, put baking soda (15 g) and a small piece of butter (20 g) into the hot liquid.
Stir the product until smooth.

The baby should drink this remedy in one go. You can give it to your child at least 3 times a day; the next day, expectoration will be more active.

How to help a child if false croup develops, Komarovsky

Often, parents who are caught by surprise begin to panic, not knowing how to alleviate the baby’s condition. There are several recommendations on how to reduce the intensity of the main signs that distinguish false croup; Komarovsky advises doing this:

ensure an influx of fresh cool air (open the windows, take the baby out onto the balcony or street);
let steam into the bathroom and let the child breathe moist air;
hold the baby's legs and arms under warm water, allowing them to warm up;
place mustard plasters on the soles of the feet to allow blood to flow out of the larynx and reduce swelling;
drip any vasoconstrictor into the nose;
Give the child a little milk with alkaline mineral water or soda.

One more thing important rule– if the night attack does not lose its intensity, immediately call emergency help.

Treatment of true croup, how it happens, what is best to use

True croup is one of the most severe diseases that most often affects children, and treatment of this disease is possible only in a hospital. Under no circumstances should you begin to influence warning signs independently, if the doctor has determined this particular diagnosis, treatment of true croup should be carried out comprehensively, and not always by taking medications. Most often, additional therapy is used to successfully combat the disease.

Treatment of the disease occurs with the following drugs:

anti-diphtheria serum (injected into a vein or muscle, depending on the stage of development of the disease);
detoxification compounds (if the disease develops rapidly, plasmapheresis may be used);
antiallergic medications;
cardiovascular drugs.

Treatment may vary slightly; everything depends on the development of the disease and the characteristics of the small organism. If the stenosis of the larynx is too obvious, it is possible to perform an operation during which the larynx is dissected and a special tube is inserted to allow the child to breathe.

Treatment of diphtheria croup - how it happens, what is used

Diphtheria croup – serious illness which, if left untreated, can lead to fatal consequences. This is why it is so important not only to consult a doctor in a timely manner, but also not to attempt to treat diphtheria croup on your own - the consequences of this can be too severe.

Treatment should be carried out only in a hospital - the child is contagious, so he should be isolated from others. If there are no complications, the baby is given anti-diphtheria serum, which significantly alleviates the baby’s condition. Simultaneously with the administration of the composition, it is possible to take antihistamines. The length of a child’s stay in hospital depends on the degree of development of the disease, if treatment was undertaken on time and took place without dangerous manifestations, then on full recovery it will take a little time.

Parents are categorically not recommended to speed up the recovery of the baby by using formulations for this. traditional medicine. The disease is too serious and can lead to fatal outcome, it is better not to take risks and completely rely on the experience and professionalism of doctors.

False croup in children, symptoms and treatment, how exactly the disease manifests itself - parents may have a lot of questions, and it is better to find answers to them in advance. It must be remembered that this disease is not entirely harmless and can cause a lot of unpleasant and even dangerous consequences for a small organism. Only drug treatment Quite aggressive medications will completely eliminate all signs of the disease and alleviate the condition of the baby.

False croup (or stenosing laryngitis) is a dangerous and frightening disease for parents. Attacks of false croup most often develop at night and in the early morning hours against the background of a viral infection. Often stenosis takes parents by surprise, and they do not know how to act correctly to help their baby. necessary help and do no harm.

Therefore, every parent needs to know the main signs of false croup, how it differs from true croup and from ordinary laryngitis.

Let's try to figure out when a child needs urgent care qualified assistance, as well as what you can and cannot do with false croup.

What is false croup? (VIDEO)

Croup- this is dangerous respiratory disease, which occurs most often in preschool and younger children school age and characterized by excessive narrowing of the larynx. Any respiratory disease respiratory systems A child’s health can lead to this condition – unfortunately, no one is immune from this.

True croup occurs only in such dangerous diseases as diphtheria. For all other diseases (ARVI, acute respiratory infections, influenza) it is observed false croup. However, it is no less dangerous and unpleasant than the real one.

False croup- this is an acute attack stenosing laryngitis or laryngotracheitis(depending on the location of the inflammatory process - in the larynx or in the larynx and). The cause of this complication is swelling of the larynx, its mucous membrane. In young children, the structure of the larynx is such that up to a certain age there is a high probability of such edema occurring.

More often, false croup occurs as a result of a viral infection of the respiratory tract - this is a parainfluenza virus, influenza virus or adenovirus. Due to the infection, inflammation occurs, which is usually accompanied by swelling of the tissues of the larynx and tracheal mucosa in the area of the vocal cords.

Exacerbation The disease usually occurs at night and often goes away on its own. But in about 10% of cases, the child may require emergency medical care, so it is still better to call a doctor at the first sign of false croup.

Laryngeal stenosis, as a rule, is observed in children 2-4 years old, sometimes it occurs in children infancy from 6 to 12 months. After 5 years, the frequency of false croup in children decreases noticeably, due to age characteristics development of the larynx.

Children's predisposition younger age to the occurrence of false croup is determined by the following anatomical features:

Small diameter of the cartilaginous skeleton
Funnel-shaped larynx
Short vocal folds
Excessive excitability of the muscles near the glottis

Main signs and symptoms of false croup: how to recognize the danger

In the middle of the night, the child was awakened by an attack of a characteristic “barking” cough; he was restless and scared. His breathing is noticeably labored and accompanied by wheezing or whistling. When you try to ask him about his health, it turns out that the baby’s voice is completely hoarse.

This is exactly what they look like main features stenosing laryngitis or false croup. Even during the day, the child might seem completely healthy to you, but by the evening he might have a slight cough, a runny nose, or a little fever - characteristic features the onset of a viral infection.

So, let's try to figure out what signs can definitely indicate this dangerous disease, How false croup:

Characteristic “barking” (“croaking”) cough
Wheezing, choked breath
Blue coloration of the nasolabial triangle
General state of anxiety and fear in the child
Hoarse voice or no voice
Frequent shallow breathing

False croup is important differentiate from true croup, which occurs in diphtheria. With diphtheria, stenosis increases gradually, and not in attacks, as with laryngitis.

How to alleviate a child’s condition: what needs to be done before the ambulance arrives?

If you notice any of the following signs in your child, you need to act immediately! After all, false croup is dangerous due to narrowing of the trachea, leading to suffocation.

First of all call ambulance crew, they will provide medical care to the child, assess his condition and decide whether he needs urgent hospitalization.

Before the ambulance arrives, try alleviate the child's condition in the following ways:

What should you never do if you have false croup?

However, there are also methods the use of which is extremely undesirable for false croup. Remember what shouldn't do to avoid deterioration of the child's condition.

No way Do not apply warm compresses on the throat or mustard plasters - they will only increase swelling.
Don't try to feed the baby, if he doesn't want to eat and doesn't ask you for food.
The baby should not be forced drink drink a lot of liquid at once, as this can cause vomiting. Let him drink as much as he wants, little by little - in small sips.
Before the doctor or ambulance arrives do not give your child antibiotics. False croup is most often caused by viruses, and antibiotics have no effect on viruses, but can provoke allergies, which will worsen the patient’s condition.
Don't use essential oils With a sharp, noticeable odor - it can provoke an even greater narrowing of the larynx.
Do not give your child cough medicines, such as Codeine, Calderpin and the like. After all, the main task with laryngitis and laryngotracheitis is to achieve a productive cough, and not to suppress it.

Degrees of stenosis in false croup

In false croup there are 4 degrees of stenosis, each of which is characterized by its own characteristics and characteristics.

First degree stenosis. Characterized by the above symptoms of false croup. The child is conscious, but usually frightened or very anxious. With anxiety, shortness of breath, hoarseness, and noisy breathing appear. Such stenosis, as a rule, can last from several hours to two days.
Second degree stenosis. Clinical symptoms intensify and cause discomfort in the child. Shortness of breath and characteristic stenotic breathing become constant. The skin turns pale. In this state, children cannot sleep, they are restless and scared. This condition can last up to five days and intensify in the form of attacks.
Third degree stenosis. Against the background of these increasing symptoms, an increase in the work of the respiratory muscles occurs. Breathing is impaired. The child’s feelings of fear and anxiety are replaced by attacks of lethargy and drowsiness - this is a consequence of hypoxia. The child's voice is hoarse. The cough turns from rough to superficial. The lower end of the sternum begins to fall in - this sign may appear in the second stage. Breathing is arrhythmic, from noisy it becomes shallow and quiet. Tachycardia may begin.
Fourth degree stenosis. An extremely serious and dangerous condition in which coma, suffocation, and convulsions are likely to develop. Severe acidosis. Superficial and heavy breathing alternates with attacks of apnea (stopping breathing). At this stage, it is possible that serious complications, life-threatening.

The listed degrees of stenosis are not intended to scare parents, but to give a clear picture of what false croup is dangerous for children, and how important it is to call a doctor in time and take the necessary measures. If the doctor insists on hospitalization– do not refuse it, as it can help preserve your child’s health in the event of a real threat.

Croup is more often associated with younger children (up to 6 years old). In later age period if it is fixed, it is only in exceptional cases. Such “indifference” to some babies, namely to their larynx, is explained by the presence in its subglottic section of loose submucosal tissue, which serves as the basis for development acute laryngitis or false croup. Such children often have a history of exudative diathesis, with a vasomotor component and other pathology associated with exposure to allergens. In other cases, false croup is the result of the presence or complication of previous viral infections (, etc.). The period of rampant influenza infection is especially dangerous for such children, so the cases of calling an ambulance due to an attack of suffocation in a child are noticeably increasing.

True croup, heavier in flow and dangerous in consequences, also gives preference children's age, but is considered as a syndrome of various diseases (more often) in which the leading role belongs to the suffering of the respiratory system.

Meanwhile, the state data (false and true croup) it is necessary to differentiate between each other and it would be good if not only the doctor, but also the parents of the “problem” child can do this. And to do this, let’s look at the main features of each individually.

"Predator" stalking children at night

He needs conditions

The inflammatory process of the mucous membrane of the larynx, accompanied by its narrowing and an attack of suffocation as a result, mainly affects preschool children (usually in the period from 3 months to 3 years). This respiratory disease is called false croup, “night predator” or long-sharp subglottic, and its development is due to the presence of the following circumstances:

Anatomical factors. The formation of the child’s respiratory system has not reached the completion stage, so the larynx remains funnel-shaped, its lumen is narrow, the tissue of the subglottic apparatus is loose, the respiratory muscles are weak, and the innervation is underdeveloped. All this creates conditions for swelling (edema) of the larynx and closing its lumen completely, which can cause not only an attack of suffocation, but also lead to the death of the baby, if he is not given help in a timely manner.

Infectious agents: The cause of the formation of an inflammatory process in the larynx, and then, as a consequence, the development of false croup, is various microorganisms: viruses (influenza, measles, scarlet fever, etc.) and bacteria (coccal flora, mycobacteria, chlamydia, etc.).
Risk factors. Decline protective forces body, presence allergic diseases are aggravating factors that help the infection to develop its activity in the child’s throat area. Pediatricians note that croup more often affects boys than girls, and that children with an overdeveloped subcutaneous fat layer, as well as those who are often and long-term ill, are more prone to this disease. In addition, false croup can cause preventive vaccinations, therefore, when observing the vaccination schedule, one should take into account general condition the health of the baby, and his allergic status separately.

Immediate cause of croup

It is not difficult to imagine how the child’s imperfect respiratory organs (larynx) will react to the development of an inflammatory process caused by viruses and bacteria in such a delicate, vulnerable place. Most likely, the inflammation will take over the area of the subglottic space and vocal cords, and as a result we will get a disease called acute stenotic (OSLT). The listed factors, individually or together in conditions of immunodeficiency, trigger the development of the inflammatory process or the response of the laryngeal mucosa (edema) to irritants in the presence of an increased allergic background. It becomes obvious that false croup is not an independent disease, but a syndrome that occurs against the background of an infectious process, the course of which becomes noticeably more complicated when added. The immediate cause of false croup is considered to be a combination of events:

(thickening due to swelling of the laryngeal mucosa by just a millimeter reduces the lumen of the organ by 50% - this is a lot);
Reflex muscle spasm ();
Closure of the lumen of the larynx formed as a result of inflammation.

It should be noted that the significance of these events is not always the same and depends on the origin of the underlying disease.

Symptoms all parents should know

Typically, croup begins when the child’s condition is no longer very stable: the baby coughs periodically, the temperature has risen to low-grade fever, and signs of respiratory infection(runny nose, ), in general, not particularly sick, but clearly not healthy either. Such periods are well known to all parents - call a doctor or wait, lead to kindergarten or leave it at home?...

Croup usually begins in the middle of the night and is easily recognized by its symptoms:

The baby is awakened by an attack of suffocation;
The child is scared, excited, waving his arms, trying to take a comfortable position;
Breathing is noisy, rapid, inhalation prevails over exhalation;
Blueness of the nasolabial triangle indicates insufficient oxygen supply to the brain (signs of hypoxia);
Strange or “croaking” cough leading to vomiting;
To inhale air, the pliable areas of the chest and abdomen are forced to retract (inspiratory shortness of breath).

The arrival of the attack in dark time day is explained by the fact that during sleep (in a horizontal position, of course) the circulation of blood and lymph in the larynx changes, the activity of drainage mechanisms decreases along with the frequency and depth of breathing. For this feature, the false croup received the name “night predator”.

Meanwhile similar symptoms can give rise to other pathological conditions:

The symptoms of false croup described above can be qualified as laryngeal stenosis of 1-2 degrees, in the event of further development of the attack, if it did not stop spontaneously or assistance was not provided, The child’s condition quickly and sharply changes towards deterioration:

The degree of respiratory and circulatory disorders increases;
The respiratory muscles work under load, chest movements lose their usual rhythm;
Shortness of breath, noisy breathing with severe difficulty in breathing;
Blue lights indicate increasing hypoxia. skin;
Anxiety, fear, and restlessness of the baby are replaced by lethargy and drowsiness;
The voice is hoarse, the “barking” cough becomes quieter and finally disappears, which is by no means an encouraging sign, similar phenomenon indicates an even greater narrowing of the larynx and the critical condition of the child.

Sometimes attacks of viral origin tend to self-limit, then the child calms down and goes to bed. But this is sometimes, but in general, Under no circumstances should you expect that everything will be over in half an hour. Calling “103” should be the first action of loved ones, who, having called an ambulance, should begin further measures aimed not only at alleviating suffering, but possibly also at saving the little person’s life.

Instead of prayer - emergency help

Visiting the “night predator” requires emergency care, therefore, waiting indifferently for the team to arrive can be dangerous for the child:

Providing first aid to a child is the duty and responsibility of the parents, because a car rushing to a call is not an airplane, it can get stuck in a traffic jam, even if it is heading with a siren, it can be delayed by other circumstances, and travel time must always be taken into account, since Not everyone lives next door to the substation.

The basis for relieving an attack of false croup is the use of hormonal drugs(prednisolone), which are included in the protocol for providing emergency care by the arriving ambulance team or are assigned to inpatient conditions. Antibacterial treatment is used if there is a complication in the form of bacterial infection. In severe cases, if conservative therapy and resuscitation does not give the desired effect, methods such as intubation and tracheotomy.

True (diphtheria) croup

This croup also occurs more often in children (features of the structure of the respiratory tract) who suffer from diphtheria, which, thanks to widespread vaccination (DTP), fortunately, occurs only occasionally in Russian open spaces. True, there are especially “literate” mothers who see harm in vaccinations and therefore refuse them. In such cases, it is not always possible to “miss” diphtheria and other childhood infections, and the child has every “chance” to find out what true croup is, which requires immediate hospitalization in an infectious diseases hospital. And here's why.

So far everything is fine...

The syndrome is characterized by slow gradual development symptoms. At first:

Without going beyond the boundaries of low-grade fever, the body temperature rises slightly;
The child’s general condition suffers little: lethargy and instability of mood appear (“whimsical and scandalous” in little ones), the child does not want to play;
Parents notice increasing hoarseness of the voice, sometimes the child coughs, the cough is wet, and his attacks are rare.

By the end of the first day we can talk about the first ( catarrhal or prodromal) period of development and manifestation two main signs of true croup:

Hoarse voice:
A completely hardened cough turns into a “barking” cough.

After 1-2 days, the prodromal period ends and the full manifestation of the disease begins, which also consists of several periods.

Prosperity is deceptive

Stenotic period may last several hours or extend up to 2 days:

The voice completely loses sound (aphonia);
A rough, but quite loud cough in the first period turns into a barely audible hissing sound, and the child coughs almost without interruption;
The third symptom of true croup appears - breathing becomes stenotic, noisy, inhalation causes difficulty;
The baby's face turns pale, he rushes about, does not respond to persuasion, cannot sleep, cries quietly, since there is no longer any sound in his voice, but when he inhales, the noise characteristic of an attack is clearly audible;
How difficult it is for a child to draw in air can be seen in the receding areas of the chest (the spaces under and above the collarbone, the spaces between the ribs) and the epigastric region. This retraction is explained by the creation of negative pressure in chest due to the fact that air does not penetrate into the lungs in sufficient quantities, as during the normal act of breathing;
The little patient occasionally calms down, his breathing somewhat evens out and becomes quieter. At such moments, the baby stops coughing, his cheeks and lips become pink, like healthy person- child on short time may even fall asleep.

Attention! Such well-being is deceptive; soon the child will be awakened by a cough, as the disease develops further and enters the pre-asphyxial phase.

The disease is already making itself felt

The pre-asphyxial phase can be recognized by a sharp change in the child’s behavior:

The patient jumps up, inhalation is impossible, there is fear and horror in the eyes, which further spasms the larynx, and the next inhalation of air requires even more effort;
The anxiety intensifies: the baby cannot find a place for himself, rushes about, cries (without a sound), stretches out his arms to be picked up and pitied;
With his mouth open, the child gasps for air, his face becomes pale, his lips blue, his forehead and whole head become covered with beads of sweat;
Paradoxical pulse causes bewilderment and concern - pulse waves drop out, although the heart continues to beat evenly and rhythmically.

In the pre-asphyxial period, the onset of asphyxia, which is very dangerous (the child may suffocate), therefore, without emergency assistance, which is emergency implementation intubation and tracheotomy are no longer possible. Of course, parents simply cannot cope with such a task. In addition, adults who are nearby and watching the child should not relax if the patient begins to slowly calm down and his breathing becomes less noisy. This is also an imaginary well-being, which arises due to the fact that in conditions of a significant lack of oxygen (hypoxia), the child gets tired, loses strength and the ability to fight for life.

When the strength to fight has run out

Signs of calm from the outside little patient should not mislead parents, especially since other symptoms clearly indicate the opposite (the disease is included in asphyxial phase):

Cheeks and lips are blue;
Cold, sticky sweat appears through the pores of the skin;
Measuring the pulse is difficult, it is barely detectable;
The heart beats quickly, the tones are muffled.

There is very little time to stop such an attack; everything lasts only a few minutes: a state of white asphyxia, when the bluish skin becomes unnaturally pale, the child stops breathing, although at some intervals isolated sobs characteristic of agony. If you do not try to carry out emergency treatment during this period surgery, death will be inevitable. The patient can be saved as long as oxygen starvation no irreversible processes occurred in his brain.

Diagnosis and complications

In order to find out the cause of terrible events, you should first of all carry out bacteriological analysis, which is the basis for diagnosing this disease. The diphtheria bacillus is looked for on dirty-gray films localized on vocal cords or, less commonly, in the subglottic space. IN lately increasingly used to detect diphtheria toxin polymerase chain reaction (PCR) and how helper method laboratory diagnostics – RNHA (indirect hemagglutination reaction).

Probably each of us remembers from the lessons of Russian literature that zemstvo doctors often took risks own life, removing diphtheria films from the oropharynx, which are the “place of residence” of the rod of the same name - main reason death of children from true croup.

When the film is separated from its location, it leaves behind traces in the form of areas of erosion covered blood clots. Occasionally, this is not limited to, extensive necrosis can form scars that permanently impair the functionality of the larynx.

Based on the location of the diphtheria films, the disease is divided into two forms:

Localized (only the larynx suffers);
Common, having two more subtypes (larynx + trachea = laryngotracheitis, larynx + trachea + bronchi = laryngotracheobronchitis).

When making a differential diagnosis, they also take into account other, clinically similar attacks:

Subchordal laryngitis;
False croup, which is described above;
Laryngeal.

Often, along with this pathology, the following are considered:

Reflex croup, resulting from irritation of the laryngeal mucosa and spasm of the laryngeal muscles (discharge of plaque, bedsores due to intubation);
Psychological croup (fear of suffocation after tracheotomy);
Allergic swelling.

True (diphtheria) croup is dangerous not only due to toxicosis and suffocation, it can be followed by complications from the cardiac and respiratory systems. In addition, it is possible to develop various kinds paralysis ( soft palate, muscles of the eye and glottis, nerves of the limbs, diaphragm).

How to treat true croup

Treatment of true croup is exclusively in a hospital setting. First aid - call an ambulance. Early diagnosis and application anti-diphtheria antitoxic serum with a localized form, in most cases it allows you to reverse the infectious disease.

The very next day you can see how the child returns to life: his cheeks turn pink, his breathing becomes quieter. You don’t have to be afraid of the patient’s lethargy and drowsiness. The baby has lost a lot of strength, so he sleeps, restoring it.

Meanwhile, in some children, there is an increase in the manifestations of stenosis caused by the discharge of films and swelling of the larynx, so in such cases you should prepare for what may be required intubation or tracheotomy. However, more often it is only possible to manage with the administration of serum, after which after two days the patient “the day before yesterday” will not be recognized: the child is calm, the voice, although hoarse, but sonorous notes slip through, the cough is rare and does not cause suffering. After about 3 days, the symptoms become a thing of the past, the baby forgets about the troubles, not realizing that his life was literally hanging by a thread. True, parents will continue to watch and listen for a long time, fearing the return of the disease.

The toxic form of diphtheria involves antibacterial treatment(antibiotics) together with antitoxic serum and, in addition, requires expansion therapeutic measures through detoxification therapy:

Plasma infusion immediately after admission to hospital;
In 3-4 hours intravenous administration glucose;
Hemodez.

Aren't adults at risk of croup?

In adults, croup is very rare, but still not completely excluded, and therefore it should also be given a little time and attention. For example, a process called phlegmonous laryngitis, is accompanied by the same symptoms of swelling, inflammation, spasm, leading to severe difficulty breathing. An infection that has entered from the surfaces of the mucous membranes or arrived through the bloodstream, that is, hematogenously, begins its development in the deep-lying tissues of the larynx, causing inflammatory process in muscles, ligaments, intermuscular tissue, often (though in varying degrees), affects the perichondrium. If suppuration is added to inflammation, it develops abscess laryngitis.

The cause of this disease, as the reader has already guessed, may be acute infection, let's say, the same diphtheria, from which adults, in general, are not insured, and also:

various localizations;
Syphilis;
Mechanical injuries and, especially, gunshot wounds and burns that open the entrance gate wider and create favorable conditions for any infectious agent.

Enough severe symptoms diseases indicate the seriousness of the situation:

Dull red swelling of a diffuse nature, involving the entire mucous membrane of the subglottic region;
Discharge of purulent exudate;
The act of swallowing is severely impaired;
Breathing is extremely difficult.

Such an inflammatory process, moving to the cricoid cartilage, causes significant trophic changes in it (chondroperichondritis), leaves persistent fistulas and, ultimately, leads to the formation cicatricial stenosis of the larynx.

Treatment consists of emergency tracheotomy, since the very first thing the patient needs is to restore breathing function. In addition, anti-inflammatory treatment, administration of gamma globulin, administration of large doses antibiotics and vitamin complexes. The formed abscess, if it exists, is eliminated during direct laryngoscopy, and the sequesters are removed at the same time.

In conclusion, I would like to assure the reader: the author knows first-hand about the origin and symptoms of croup (being a doctor, he experienced it firsthand as his children grew up), and hopes that this material will help parents prevent the stage when an ambulance rushing with a siren ”, does not have time to deliver a healthy and cheerful child yesterday. It all depends on us, adults, because the baby can only cry quietly and ask to be pitied, so in any case, it’s better to be safe.

Video: laryngitis and croup, “Doctor Komarovsky”

False croup, or acute stenosing laryngotracheitis, is a symptom complex that develops with inflammatory changes in the mucous membrane of the larynx and trachea due to edema in the subglottic space.

Causes and mechanisms of development of false croup

Main reason this state is an acute respiratory viral infection, caused (most often) by influenza, respiratory syncytial virus and adenovirus.

Less commonly, acute stenosing laryngotracheitis can be caused by bacteria - mainly streptococcus and staphylococcus.
Often, false croup is the body’s reaction to exposure to a particular allergen, as well as a consequence of local trauma.

In adults, false croup practically does not occur - in them only true croup is possible, which develops with such infectious disease like diphtheria.

False croup is a common complication in children under 6 years of age. This is due to the anatomical and physiological characteristics of the upper respiratory tract of babies, namely:

small size and narrow lumen of the larynx;
a large amount of loose connective and lymphoid tissue in the subglottic space (than younger child, the more this tissue is, and it is highly susceptible to swelling);
elongated, loose epiglottis;
softness of the cartilaginous skeleton;
highly developed circulatory and lymphatic systems in the area of the upper respiratory tract.

The above features contribute to the occurrence of stenosis components against the background of inflammation - spasm and edema.

So... Due to inflammatory changes in the mucous membrane of the larynx, manifested by edema and the production of viscous discharge, the lumen of the larynx narrows, its mucous membrane dries out, crusts form on it, causing the lumen of the larynx to narrow even more. When a child is restless, a reflex spasm of the smooth muscles of the larynx also occurs.

Manifestations of the disease

Symptoms of false croup: hoarseness, dry barking cough, difficulty breathing.

Acute stenosing laryngotracheitis is characterized by the presence of 3 symptoms simultaneously:

annoying, rough barking cough:
hoarseness, hoarseness of voice – dysphonia;
so-called inspiratory stridor - difficult whistling, wheezing, bubbling breathing.

In addition to the above symptoms, the patient may have other signs of the underlying disease: elevated temperature body, runny nose, discharge from the conjunctiva (usually with adenovirus infection), lacrimation.

It should also be noted that the described condition usually develops in the evening or at night during sleep, when the child is in a horizontal position.

In practical medicine, it is customary to distinguish 4 stages of laryngeal stenosis:

I – compensated stenosis. The child's condition is assessed as medium degree gravity. His consciousness is clear. At rest, breathing is free, even, with motor or emotional excitement shortness of breath appears - when breathing, retraction of the jugular fossa (located above the sternum) and intercostal spaces is noticeable. Heart rate is 5–10% higher normal values for a given age. A rough barking cough occurs periodically.

II – subcompensated stenosis. The patient's condition is serious. The child is excited, his skin is pale, around the mouth there is a cyanotic tint. At rest, shortness of breath is noted - a loud inhalation with retraction of the intercostal spaces, jugular and supraclavicular fossae. The bubbling breath is interrupted by bouts of rough deep barking cough. The voice is significantly hoarse. Heart rate is 10–15% higher than normal.

III – decompensated stenosis. The child's condition is extremely serious. There is confusion, pronounced lethargy, or, conversely, agitation. There is inspiratory shortness of breath with extremely difficult inhalation, which is accompanied by a sharp retraction of the supraclavicular and jugular fossae, intercostal spaces, and epigastric region (the area under the sternum - between the ribs and the navel). Exhalation is reduced, the skin is pale, cyanosis spreads. The heart beats more than 15% faster than normal. Blood pressure drops.

IV – asphyxia – the child’s condition is extremely serious. There is no consciousness. Skin with a bluish tint (cyanotic). The pupils are dilated. Breathing is shallow, infrequent or absent altogether. Heart sounds are muffled and their frequency is very difficult to calculate. The pressure is sharply reduced. Convulsions are possible.

Diagnosis and differential diagnosis

Diagnosis is not difficult. The diagnosis is made by an emergency physician, pediatrician or otorhinolaryngologist based on medical history (the condition developed against the background of acute respiratory viral infection), typical clinical picture disease (the triad of symptoms described above), results objective examination patient (visual examination, assessment of breathing pattern, cardiac activity, monitoring of indicators blood pressure). In a hospital setting, laryngoscopy is performed (for the purpose of visually assessing the condition of the mucous membrane), taking a smear from the pharynx, followed by microscopic examination and inoculation on a nutrient medium (to verify the pathogen). In order to assess the degree of oxygen starvation of the body, a study is carried out gas composition blood and acid-base status.

According to indications for the purpose of diagnosing the underlying disease or possible complications can be carried out:

otoscopy;

False croup must be differentiated from true diphtheria croup, acute epiglottitis, retropharyngeal abscess, foreign body in the larynx and acute obstructive bronchitis.

True diphtheria croup is accompanied by low (subfebrile) temperature, in a hoarse voice(the patient seems to be “talking through his nose”). There are no runny nose or other catarrhal symptoms. Signs of stenosis develop gradually. Upon examination oral cavity The tonsils attract attention: they are enlarged, with dirty gray films that are difficult to remove with a spatula. The patient's mouth smells of rot.

Acute epiglottitis is an inflammation of the epiglottis area. Signs of laryngeal stenosis increase gradually and are characterized by severe inspiratory shortness of breath, dysphagia and general anxiety of the patient. His condition is serious, his body position is forced (sitting), his temperature rises to febrile levels. Examining the oral cavity, you can see the root of the tongue is dark cherry in color. During laryngoscopy - swelling of the epiglottis and epiglottis.

A retropharyngeal abscess always debuts acutely with an increase in body temperature to febrile levels, increasing shortness of breath with difficulty in inhaling, turning into suffocation, and severe general anxiety. The patient's position is forced - with the head tilted back and to the affected side. Breathing is snoring, difficult especially when the patient is lying down. Salivation increased. When examining the pharynx, there is a noticeable bulging of the posterior wall and a symptom of fluctuation, indicating the presence of inflammatory fluid in the area of examination.

In favor of presence in the larynx foreign body, partially closing the lumen of the organ, indicates a sudden onset of the disease, the patient’s anxiety, complete absence signs of inflammation and intoxication. In case complete obstruction the patient cannot take a breath or speak. Points fingers at neck. Inspiratory stridor and paroxysmal cough are noted.

If false croup has developed once, parents should keep in mind that it may recur, and, after consulting with a doctor, stock up on medications that may be useful if the disease occurs.

About the treatment of false croup in the program “School of Doctor Komarovsky”: