What causes false croup? How to treat false croup in a child. Diagnosis and differential diagnosis

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 of a child’s respiratory system 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 reason for 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 arises as a result viral infection respiratory tract 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 the child will be assessed and his condition will be determined 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 afraid 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. Extremely difficult 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 action 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.

False croup is a manifestation of acute respiratory infection, in which children experience choking and an unusual “barking” cough. Parents should know how to alleviate the baby’s condition before the ambulance arrives, and what procedures will restore breathing. You cannot try to cure a child on your own using dubious advice. With this disease, examination is required for an accurate diagnosis, since similar symptoms also occur in other pathologies. Particular care must be taken when providing first aid to a child suffering from allergies.

False croup usually appears in children older than 6 months. In more early age child on breastfeeding, protected from the effects of infection by maternal immunity.

Most often, children aged 1-5 years suffer from false croup. In children over 6 years of age, this pathology is extremely rare, since their respiratory system organs are more developed and their immunity is quite strong.

Causes of infectious stenosis

The main cause of false croup is the presence of acute or chronic infectious diseases respiratory organs.

Those most at risk for this complication are: premature babies, as well as those with birth trauma. It often occurs in children suffering from allergies or chronic diseases respiratory organs. Increased excitability of the nervous system contributes to the occurrence of croup.

Infectious diseases with similar manifestations Children with immunodeficiency syndrome, as well as children with vitamin deficiency and rickets, are especially susceptible.

Boys get sick more often than girls. State of suffocation and painful cough can occur repeatedly, with any cold, until the body gets stronger (this happens after 6 years).

Possible consequences in children

If the parents managed to stop the attack of croup at home, the baby felt better, he still must be taken to the doctor. If proper treatment is not carried out, bronchitis, otitis media, sinusitis, and conjunctivitis may develop. Inflammation of the larynx can develop into pneumonia, purulent meningitis.

What can be confused with

True croup. In this case, children experience suffocation due to the formation of films in the larynx, blocking the airways. This condition, unlike false croup, develops gradually. It is recognized by the presence of a gray-white coating on the tonsils.

With false croup, you can improve the child's condition by eliminating swelling and causing a cough, which allows you to clear the lumen of the larynx from mucus. The patient's voice becomes hoarse, but does not disappear at all. With true croup, it is imperative to remove the films using a laryngoscope and a suction device. The voice disappears completely.

Bronchial asthma. This disease is also characterized by suffocation, but there is a significant difference: with false croup it is difficult to inhale air, but it is exhaled normally. But with asthma, on the contrary, it is easy to inhale, but difficult to exhale.

Allergic stenosis of the larynx– the spasm occurs suddenly, the patient’s condition rapidly deteriorates. The difference is that stenosis and suffocation are the body’s response to exposure to any allergen.

Hit foreign body into the trachea. Just like with allergies, the cause of suffocation is not the development of an infection in the body.

Types and forms of false croup

The infectious form develops as a result of both viral and bacterial diseases. Depending on the severity of the manifestations, there are the following types laryngeal stenosis:

compensated, in which difficulty breathing occurs in a state physical activity;
subcompensated, when suffocation occurs even if the child is lying or sitting;
decompensated manifests itself in the child both at rest and during movement;
terminal (asphyxia) occurs in the form acute attack, in which breathing is completely blocked. If help is not provided urgently, cardiac arrest occurs.

False croup has three forms.

Edema form occurs in children under the age of 1.5-2 years. The diameter of the lumen of their larynx is too small, and it itself is shortened. Such features anatomical structure lead to the fact that even the slightest swelling significantly complicates breathing.

Infiltrative. Develops at the same age if purulent inflammation occurs in the upper part of the larynx inflammatory process.

Obstructive. Inflammation and swelling spread to the entire larynx, and if a bacterial infection joins a viral infection, the process also develops in the bronchi. This is the most dangerous form croup, which leads to asphyxia. This development of the disease occurs in children over 2 years of age.

Symptoms of false croup

As a rule, an attack occurs in a child at night or in the morning. The baby wakes up screaming and exhibits the following symptoms:

Hoarse breathing with difficulty inhaling.
Boring "barking" cough. The child tries to cough up the obstructive sputum, but it is scanty and sticky. Severe coughing can cause damage to small blood vessels in the bronchi, and then bloody streaks appear in the sputum.
The voice changes, it becomes hoarse.
The child is afraid that he cannot breathe normally, he is very excited, his eyes are open.
The cough is often accompanied by vomiting.
As a result of lack of air, the child's skin turns pale. Lips and fingertips take on a blue tint.
Symptoms of the underlying disease that led to the appearance of such a complication are observed.
There is a sore throat, runny nose, and fever.

When false croup in a child passes into the terminal form, the skin on the entire body turns blue, the child’s breathing becomes shallow, heart failure appears, febrile state. If a bacterial infection is added to a viral infection, fever, progressive shortness of breath occur, and necrosis of laryngeal tissue may occur, which sometimes causes death.

Signs of bacterial croup are most severe in children under 2 years of age. They usually intensify on the 3rd-5th day of illness. Urgent treatment is required to eliminate bacterial infection.

If there is no bacterial infection, then suffocation and other danger signs completely disappear on the 2nd day of illness.

Video: Signs of false croup. First home aid

Diagnostics

The diagnosis is made after studying external manifestations illness and establishing the nature of the disease that caused such a complication.

To distinguish false croup from other diseases, the doctor pays attention to the presence of the following signs:

bluish skin tone, pallor of the nasolabial triangle;
difficulty breathing, retraction pectoral muscles between the ribs;
increase in frequency breathing movements;
wheezing noisy breathing, increased heart rate.

After examining the patient and listening to the respiratory system, laryngoscopy is performed to examine the patency of the airways. The research is carried out indirect way(using a reflector placed on the doctor’s forehead), as well as in a direct way (inserting a laryngoscope into the larynx).

A throat swab is examined using PCR methods and ELISA to determine the type of infection. If there is doubt about the nature of the pathology, a culture is done to detect the sensitivity of bacteria to antibiotics.

A blood test for leukocytes is performed. If necessary, a chest x-ray is taken. Using mirrors, the condition of the mucous membranes of the nose is studied, and the auditory canal and eardrum are also examined.

First aid for a child during a seizure

If a child has an attack of barking cough, and there are other signs of false croup, it is necessary to call " ambulance“, and before her arrival try to ease the suffocation. You must try not to show your anxiety to the child, otherwise he will become even more frightened, which can intensify the spasm of the laryngeal muscles.

To make breathing easier, it is necessary to provide an influx of fresh, cool and moist air. If it is too dry, you need to moisten it artificially. To do this, hang it in the room wet towels, spray water, place a bowl of water.

You can let your child breathe in the steam; to do this, go into the bathroom with him, open the tap with hot water or shower. Need to warm his hands warm water. Mustard plasters are placed on the soles of the feet in order to improve blood flow from the larynx and reduce its swelling.

You can do inhalation saline solution using a nebulizer.

Warning: You should not inhale over potatoes, as the irritating effect of the substances contained in them will cause an increase in coughing and intensify spasm of the larynx. It is useful to carry out inhalation over a soda solution, but this must be done carefully so that the child is not afraid and does not struggle, otherwise he may, firstly, get burned, and secondly, nervous stress will only make the suffocation worse. You can breathe steam over a thermos or kettle without covering the child’s head with a towel, but throwing it, for example, over an umbrella, under which you sit with the baby.

If the child cannot breathe through the nose, it is necessary to instill a vasoconstrictor (otrivin, Nazivin). Give warm milk mixed with alkaline to drink mineral water(for example, Borjomi) or adding a drop of soda. This will help reduce throat irritation and ease coughing.

To free the larynx from sticky mucus, you can induce vomiting by pressing on the root of the tongue or the back wall of the pharynx. If the baby is not allergic to plants, give him warm chamomile tea, plantain or sage infusion (infuse 1 tbsp for 10-15 minutes. dried herb in 1 glass of boiling water). You need to drink in small portions, but often.

If the condition is serious, the child is hospitalized.

Treatment in hospital

The hospital provides treatment to normalize the patient's breathing. Antihistamines (suprastin, pipolfen, tavegil) are administered intravenously. Sedatives are used. To eliminate swelling of the laryngeal muscles, diuretics are prescribed.

Oxygen therapy is carried out, that is, to weaken an attack of false croup, the child is allowed to breathe air with a high oxygen content. During treatment in a hospital, inhalations with naphthyzine (a vasoconstrictor) and also with pulmicort (a hormonal drug) are made using a nebulizer. To suppress cough, corticosteroid drugs are also administered intramuscularly or intravenously during treatment. Doses of prednisolone or hydrocortisone are selected strictly individually, taking into account the weight and age of the baby.

Except emergency therapy Treatment with antiviral drugs (such as arbidol, viferon, algirem) is also carried out. If a bacterial infection is detected, antibiotic treatment is prescribed.

To speed up the removal of sputum, drugs that have an expectorant effect (ambrobene, bromhexine, lazolvan) are prescribed. These drugs are given to children in the form of syrup. Erespal (an anti-inflammatory drug) is used in the same form. Vitamins are prescribed.

Doctors advise parents to pay special attention to the need preventive vaccination from the most severe infectious diseases, a dangerous complication of which is false croup. During ARVI epidemics, it is recommended to use antiviral drugs (influenza, viferon) in the form of ointments or nasal drops.

False croup in children is a syndrome characterized by a triad clinical symptoms: wheezing (wheezing), barking cough, hoarseness. The syndrome is formed in diseases accompanied by an acute inflammatory process in the mucous membrane of the larynx and trachea.

With false croup, the inflammatory process is localized on the mucous membrane of the subglottic (subglottic) area of the larynx.

The development of false croup is associated with three main mechanisms:

the inflammatory process causes swelling of the space under the vocal cords, which narrows the lumen of the larynx;
reflex spasm of the laryngeal muscles causes obstruction;
the secretory activity of the glands of the mucous membrane of the larynx increases, and the already narrowed lumen of the larynx becomes clogged with a viscous inflammatory secretion.

Parents of children who are prone to recurrent attacks of false croup need to ensure that the correct microclimate is maintained in the room where the child is.

False croup most often occurs in infants and preschool age. This is due to the anatomical and physiological characteristics of the children's larynx and trachea:

small diameter of the lumen of the trachea and bronchi, short narrow vestibule, funnel-shaped (instead of cylindrical) shape of the larynx;
relative weakness of the respiratory muscles;
disproportionately short, high-lying vocal folds;
hyperexcitability of the adductor muscles that close the glottis;
functional immaturity and susceptibility of reflexogenic zones;
abundance lymphoid tissue with weak development of elastic fibers in the mucous membrane and submucosa, prone to the development of edema.

Source: miksturka.info

Synonyms: acute stenosing laryngotracheitis, viral croup, pseudocroup.

Causes of false croup in children

The most common cause of false croup in children is a viral infection. To the most typical pathogens diseases include influenza viruses, parainfluenza, herpes, measles, chickenpox, whooping cough, and adenoviruses. Prevailing etiological factor is parainfluenza virus type I. The syndrome can also occur as a complication of adenoiditis, acute pharyngitis, chronic tonsillitis, measles, rhinitis, scarlet fever, influenza, chickenpox, ARVI.

False croup of bacterial etiology is less common. As a rule, bacterial microflora(Haemophilus influenzae, streptococci, staphylococci, pneumococci) joins the viral one in case of weakened immunity.

TO non-infectious causes false croup in children includes injuries of the larynx, allergic edema, kidney diseases and cardiovascular system. Mechanical blockage of the lumen of the larynx can occur due to aspiration of foreign bodies.

With an uncomplicated course, false croup in children, as a rule, ends in recovery.

Contributing factors are: decreased immunity, increased excitability of the nervous system, rickets, vitamin deficiency, a tendency to allergic reactions, exudative-catarrhal and lymphatic-hypoplastic diathesis, birth injuries, fetal hypoxia suffered during childbirth, paratrophy, post-vaccination period, artificial feeding, congenital stridor, hypertrophy of the lymphadenoid ring.

Forms

Depending on the cause of the disease, viral and bacterial false croup are distinguished.

Based on the presence/absence of complications, false croup in children can be complicated or uncomplicated.

Based on clinical manifestations There are four degrees of stenosis:

Compensated.
Subcompensated.
Decompensated.
Terminal (asphyxia).

Symptoms of false croup in children

Symptoms of false croup in children depend on the degree of laryngeal stenosis. The syndrome usually develops on the second or third day of an acute infectious disease with damage to the upper respiratory tract, mainly in the evening or at night. The onset is sudden and acute. The child becomes restless, noisy breathing, inspiratory type of shortness of breath, and rough, barking coughing attacks appear. The severity of the condition is determined by obstructive respiratory failure, the severity of toxicosis, and the addition of complications.

Source: fantasyclinic.ru

With 1st degree laryngeal stenosis the following are observed:

no signs of impairment external respiration at rest, inspiratory dyspnea during physical exertion and anxiety;
shortening or loss of respiratory pauses between inhalation and exhalation;
increase in depth and noise of breathing;
the presence of isolated wheezing in the lungs, appearing mainly on inspiration;
bradycardia and compensated respiratory acidosis.

Before the doctor arrives, it is first necessary to provide the child with access fresh air, calm down, give a warm alkaline drink.

For 2nd degree stenosis clinical symptoms increases, the phenomena of stenosis can be permanent or paroxysmal in nature. Signs of 2nd degree:

stenotic breathing at rest and during exercise, constant shortness of breath of an inspiratory nature, audible at a distance;
significantly hoarse voice;
retraction of compliant places of the chest (jugular fossa, supraclavicular and subclavian fossae, intercostal spaces, epigastrium) due to increased work of the respiratory muscles;
dry wheezing in the lungs;
pallor of the skin and visible mucous membranes, perioral cyanosis (bluish coloration of the nasolabial triangle), worsening during a coughing attack;
tachycardia, anxiety, sleep disturbances;
subcompensated respiratory or mixed acidosis.

Grade 3 stenosis is characterized by signs of respiratory decompensation and circulatory failure, a sharp increase in the work of the respiratory muscles. Symptoms of grade 3 stenosis:

superficial, quiet cough;
sharply hoarse voice;
pronounced cyanosis of the nasolabial triangle, pallor of the skin;
paradoxical breathing, inspiratory shortness of breath with extremely difficult inhalation;
an increase in breathing resistance, which leads to activation of the respiratory muscles and a sharp retraction of the yielding areas of the chest;
maximum excursions of the larynx during inhalation and exhalation;
rough wheezing of various sizes, and then a uniform weakening of breathing in the lungs during inhalation and exhalation;
hypoxemia ( reduced content oxygen in the blood);
sticky cold sweat on the scalp and face;
muffled heart sounds, arrhythmia, tachycardia, paradoxical pulse (loss of pulse wave or slower pulse on inspiration);
anxiety, feeling of fear or lethargy, drowsiness, confusion.

You can use reflex therapy: prepare foot bath to cause reflex vasodilation, press on the root of the child’s tongue to provoke vomiting, tickle his nose, causing a reflex sneeze.

With grade 4 stenosis, there is a sharp deterioration in breathing, and the severity of inspiratory dyspnea and obstructive syndrome increases. Terminal symptoms:

shallow, frequent, intermittent or arrhythmic breathing with periodic apneas;
pale skin with an earthy tint, nail phalanges sharply cyanotic;
atony of the diaphragm, vocal folds;
thread-like pulse, difficult to determine;
convulsive syndrome;
sharpening of facial features, dilation of pupils;
drop in blood pressure, muffled heart sounds, bradycardia, then asystole;
hypoxemia and hypercapnia, deep combined acidosis;
confusion, possible hypoxic coma.

The child's condition is extremely serious, he becomes indifferent, indifferent, and does not ask for help. False croup with grade 4 stenosis has high risk death due to paralysis of the respiratory center.

Diagnostics

The diagnosis of false croup in children is based on the presence of a characteristic triad of symptoms, auscultation data, and laryngoscopy.

When auscultating the lungs, wheezing and stridor breathing are heard.

In order to visually assess the condition of the mucosa, laryngoscopy is performed. During laryngoscopy, swelling of the mucous membrane of the subglottic space and prolapse of the epiglottis can be detected.

Bacteriological analysis (smears from the surface of the palatine arches and the back wall of the pharynx, nose) is carried out to exclude diphtheria, identify and identify a pathogen of a bacterial nature. The establishment of mycoplasma or chlamydial flora is carried out using ELISA and PCR methods.

To assess the degree oxygen starvation the body is examined gas composition blood and acid-base balance.

Diagnosis of complications, if necessary, includes pharyngoscopy, rhinoscopy, otoscopy, radiography of the lungs and paranasal sinuses.

Hospitalization in the intensive care unit and intensive care Children with stage 3 false croup, as well as those with progression of grade 2 stenosis during therapy, are eligible.

Differential diagnosis is carried out with true diphtheria croup, epiglottitis, acute obstructive bronchitis, foreign body in the larynx or trachea, laryngeal papillomatosis, retropharyngeal abscess, and other diseases that may be accompanied by laryngeal stenosis.

Treatment of false croup in children

Treatment of false croup in children involves early hospitalization with complete and timely etiopathogenetic therapy.

Before the doctor arrives, first of all, it is necessary to provide the child with access to fresh air, calm him down, and give him a warm alkaline drink.

You can use reflex (distractive) therapy: prepare a foot bath to cause reflex vasodilation, press on the root of the child’s tongue to provoke vomiting, tickle his nose, causing a reflex sneeze.

Further treatment is carried out in a hospital. The choice of methods is determined by a specialist and depends on the severity of the stenosis and the severity of the child’s condition.

Etiotropic therapy involves taking antiviral drugs, interferons. In case of joining bacterial complications and for severe laryngeal stenosis it is prescribed antibacterial therapy. For subcompensated and decompensated stenoses of the larynx, it is indicated parenteral administration corticosteroids, inhaled hydrocortisone. To influence the spasmodic component, drugs are used that reduce contractile activity and tone of the muscles of the larynx and trachea.

Considering the possibility of an allergic component participating in the development of false croup, antihistamines are included in the complex of therapeutic measures to eliminate edema.

Non-infectious causes of false croup in children include laryngeal injuries, allergic edema, kidney and cardiovascular diseases. Mechanical blockage of the lumen of the larynx can occur due to aspiration of foreign bodies.

Mucolytic and expectorant drugs help thin and remove mucus from the respiratory tract; they are usually prescribed in the form of aerosols and inhalations, sometimes in the form of syrups, throat softening lozenges.

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 cases of calling an ambulance due to a child’s asthma attack 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, these conditions (false and true croup) need to be differentiated from 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 imperfect respiratory organs (larynx) of a child will react to the development of an inflammatory process caused by viruses and bacteria in such a delicate vulnerable spot. 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 infectious process, the course of which becomes noticeably more complicated with the addition. 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

Usually, croup begins when the child’s condition is no longer very stable: the baby coughs periodically, the temperature has risen to low-grade, signs of a respiratory infection have appeared (runny nose, etc.), 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, others can give similar symptoms 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;
Increasing hypoxia is indicated by blue 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; such a 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

A visit to a “night predator” requires emergency care, so 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 stopping 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 prescribed in an inpatient setting. Antibacterial treatment is used if there is a complication in the form of a bacterial infection. In severe cases, if conservative therapy and resuscitation do 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-asphyxia 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 on the part of a small 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 until irreversible processes occur in his brain due to oxygen starvation.

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 of diagnosis of 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 as a 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 bacillus of the same name - the main cause of death in 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 edema.

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 requires 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 an inflammatory process in the muscles, ligaments, intermuscular tissue, often (though in varying degrees), affects the perichondrium. If suppuration is added to the 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.

Quite pronounced symptoms of the disease 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 of 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 first-hand 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”

Croup is a rather dangerous disease of the respiratory system, which occurs as a complication of acute infectious and inflammatory processes in the respiratory organs. Due to some anatomical and physiological features child's body most susceptible to development of this disease small children.

The main danger of croup for the patient’s health is the increasing respiratory distress, which appears due to narrowing of the larynx and upper sections trachea. Therefore, this disease has another name - stenotic (that is, accompanied by a persistent narrowing of the lumen of the organ) or laryngotracheitis.

There are two types of croup:

True. It develops only with diphtheria. The pathology is based on specific fibrinous inflammation with the formation of films on the mucous membrane of the larynx (in the area of the vocal folds). A person's airways become clogged with these films, and suffocation occurs.

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False. It is a complication of other infectious and inflammatory diseases of the respiratory system. Obstruction of the respiratory tract with this type of croup occurs mainly due to swelling of the walls of the larynx (and the same vocal folds).

False croup is the most common, so it will be the main focus of this article.

Depending on the prevailing pathological changes, false croup can occur in various forms:

in edema, in which serious condition the patient is caused by swelling of the respiratory tract;
in hypersecretory, characterized by abundant formation of viscous sputum, blocking the lumen of the larynx;
in spasmodic, caused by spasm of the respiratory system;
in mixed, in which several pathological manifestations are present at once (edema and hypersecretion, edema and spasm, etc.).

Causes of croup

Croup in a child can occur due to the following infectious diseases:

and - in most cases.
Illnesses caused by respiratory syncytial virus and.
Inflammatory diseases of the respiratory system of bacterial nature.

Why do children most often develop croup?

Children aged 6 months and older are most susceptible to developing false croup. up to 3 years; in older age, this syndrome is much less common. This pattern is explained by some anatomical and physiological features of the child’s respiratory tract:

What happens in the respiratory tract during croup?

An acute inflammatory process in the larynx is usually accompanied by swelling of the mucous membrane and the formation of mucus. If this swelling is pronounced (especially in the narrowest place of the larynx - in the area of the vocal folds and under them), the lumen is partially blocked at first, and with increasing pathological changes - to a critical level, as a result of which the patient cannot inhale normally and suffocates. This is croup. A significant accumulation of sputum and spasm of the laryngeal muscles contribute to the obstruction of the airways in this disease. Moreover, it is very important that the child’s anxiety, screaming and crying only intensify the spasm of the respiratory system.

The likelihood of developing croup is especially high at night. This is explained as follows physiological phenomena: when a child lies for a long time, the outflow of blood and lymph from the tissues occurs somewhat differently (therefore, swelling increases), the drainage activity of the respiratory tract decreases (mucus accumulates in them). If there is also dry warm air in the room, which dries out the mucous membranes, there is a risk of respiratory disorders increases significantly.

Croup is characterized by a triad of symptoms:

barking paroxysmal cough;
stridor (noisy breathing), especially when the child cries or is agitated;
hoarseness of voice.

In addition, secondary signs of the disease appear - severe anxiety, rapid breathing and heartbeat, nausea, hyperthermia.

Increasingly respiratory failure all symptoms worsen, the child’s skin becomes gray or bluish, salivation increases, wheezing becomes audible even when calm, and anxiety is replaced by lethargy.

Diagnosis of croup

Croup in a child is diagnosed based on characteristic clinical picture and the presence of symptoms of an infectious-inflammatory disease of the respiratory organs. Carry out some additional research V similar situations there is simply no time, since assistance to the patient must be provided immediately.

Other pathological conditions may also have symptoms similar to croup: foreign body aspiration (for example, parts of toys entering the respiratory system), allergic swelling of the airways, laryngeal injuries, sudden laryngospasm, epiglottitis and others. The approach to the treatment of these ailments is somewhat different, so it is impossible to independently treat a child who has manifestations of airway obstruction.

First aid for croup

The first thing parents should do when their child develops symptoms of croup is to call an ambulance. Next, do the following (before the doctors arrive, you can try to alleviate the baby’s condition):

Take the child in your arms and calm him down. As mentioned above, fear and anxiety lead to increased spasm of the respiratory tract.
Wrap the patient in a blanket and bring him to open window or take it out onto the balcony (it needs access to cold air). You can also bring your child into the bathroom, which has a faucet running with cool water (not hot!).
If there is a nebulizer in the house, give the child saline solution or mineral water to breathe.

Important! Any steam inhalations, rubbing and other similar procedures for croup are contraindicated.

Treatment of croup

Children with symptoms of croup should be hospitalized. The first thing doctors must do is restore the airway. To do this, it is necessary to reduce swelling and spasm of the larynx, as well as free its lumen from accumulated mucus. Therefore on prehospital stage, and then in a hospital setting the patient is given the following treatment:

If ineffective conservative therapy tracheal intubation or tracheotomy is performed followed by artificial ventilation lungs.

Since false croup most often occurs in children against the background of croup, its development can be prevented by preventing “colds”. In addition, an important role in preventing the occurrence of stenosing laryngitis plays correct behavior parents with flu and other similar ailments in their child. It is the implementation of the doctor’s recommendations, the creation comfortable conditions in the patient’s room (clean, moist, cool air), drinking plenty of fluids, regular nasal rinsing, and not advertised medications, can reduce the severity of pathological changes in the respiratory organs.

In addition, during acute respiratory infections it is not advisable to do the following: apply mustard plasters, rub the patient with essential oils, give the baby citrus fruits, honey and other potential allergens. All this can cause a reflex spasm of the laryngeal muscles and provoke the development of croup.

Important: Parents of children who have had croup before should definitely consult with their pediatrician about how to behave if the child develops the first threatening symptoms of respiratory disorders, and what medications for emergency assistance must be in your home medicine cabinet.

Zubkova Olga Sergeevna, medical observer, epidemiologist