Komarovsky viral croup in children. Symptoms, treatment and prevention of croup in children. Allergies to medications in children

Check out the symptoms of this dangerous disease:

5.9. Laryngitis, tracheitis, laryngotracheitis
5.10. Stenosing laryngotracheitis. Croup
10.25. Principles of complex treatment

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Croup in children

It is well known that children in the first years of life are susceptible to many diseases, since their immunity cannot fully resist pathogenic viruses and bacteria. Most often, young children suffer from infectious diseases: measles, diphtheria, laryngitis, croup. At the same time, croup is considered one of the most severe conditions in children in the first years of life. Therefore, we decided to consider this disease in children in more detail. How to distinguish true croup from false? Is it possible to independently recognize the disease in a child? What to do if signs of croup appear in infants? We will try to answer these and many other questions in our article today.

Croup is acute subglottic laryngitis. With this disease, viral infections such as influenza, diphtheria, measles cause swelling and inflammation of the loose fatty tissue located under the vocal folds in the child. The danger of measles is explained by the fact that tissue swelling causes a narrowing of the lumen of the larynx and difficulty breathing. If the child is not provided with medical assistance in time, he may develop asphyxia - suffocation.

Most often, croup occurs in children whose immunity is severely weakened, as well as in babies prone to allergic reactions, those born prematurely and those who have suffered birth injuries.

True and false croup in children: symptoms

Fortunately, true croup is relatively rare today due to the decreasing prevalence of diphtheria. However, isolated cases of the disease are still recorded. Alone or in combination with a throat infection, young children may develop laryngeal diphtheria. This condition is called true croup. Membranous fibrous deposits spread to the mucous membrane of the larynx, which can subsequently lead to muscle spasm and asphyxia.

The signs of this pathology intensify quite quickly. If at first you only notice hoarseness in the baby, then after a few hours the child completely loses his voice. A disorder of the breathing process is most often observed at the end of the first - at the beginning of the second week of diphtheria. Even from a distance you can hear the child breathing heavily. In addition, he may develop an attack of suffocation, in which the baby turns blue, and he experiences a drop in cardiac performance. True croup in children is severe and often requires surgical intervention, so if all these symptoms are present, it is necessary to act without delay.

As for false croup, this form of the disease is characterized by rapidly developing swelling of the laryngeal mucosa. The cause of the disease can be various viral bacteria of the upper respiratory tract, as well as a chemical or thermal burn of the larynx. Edema is rarely accompanied by muscle spasms in the respiratory organs, but this disease can also cause asphyxia if you do not consult a doctor in time.

It is also important to note the fact that with false croup the child suddenly finds it difficult to breathe. In addition, shortness of breath, “barking” cough, anxiety, and fear are noted. With this form of pathology, the child rarely loses his voice. As for an attack of suffocation, it can last about three to four hours, and relapse is quite possible.

So, common symptoms of croup in a child are breathing problems, which can quickly progress to life-threatening symptoms. Signs of a serious problem include:

swallowing disorder;
incessant drooling;
bluish color of skin or lips;
sucking movements of the chest;
fast breathing (80 breaths per minute).

As soon as you notice certain symptoms of false croup, immediately call emergency doctors to save the life of your child.

Is croup contagious and how is it transmitted in children?

Croup, or laryngotracheitis, acute laryngitis is an infectious disease that is usually transmitted by airborne droplets. Therefore, this disease is contagious. After infected air enters the child's lungs, symptoms of croup develop within 2-3 days. In this case, the infection can persist for several days on doors, furniture, toys and other household items.

If your child complains of a sore throat, his voice is hoarse, or he has a dry “barking” cough that gets worse at night, then you must isolate the baby from other children and immediately seek help from a doctor. Note that with croup, a child’s cough is accompanied by fever, and wheezing may occur. Babies with croup are irritable, lethargic, and have poor appetite. All of the above symptoms may indicate that your child has contracted croup.

Croup in children: treatment

The first thing parents should do before the doctor arrives is to calm and console the child. Unnecessary worries and fear can worsen the baby’s breathing. It is very important to isolate the child at the initial stage of the disease. To make breathing easier, place your baby close to warm steam or a humidifier. Also, during attacks with breathing problems, you can let the child breathe moist air in the bathroom. To do this, you need to open the hot water tap and wait until the bathroom is filled with steam. You can breathe this air for minutes.

If coughing or breathing problems worsen at night, you can take the child out to the balcony so that the baby can get some fresh air. In addition, in order to avoid blockage of the nasal cavity with mucus, children with symptoms of croup are recommended to instill a saline solution into the nose - 1 teaspoon per 250 ml of water.

Decongestants and medications may be effective to suppress cough. But they should be prescribed by a doctor, since some combinations of cough and cold medications can only aggravate the baby’s painful condition. Especially if they contain dextromethorphan and diphenhydramine (Benadryl).

Drugs such as Acetaminophen (Tylenol, Panadol) and ibuprofen (Motrin, Advil) are effective for pain and fever. It is important to note that aspirin is excluded in the treatment of croup, laryngotracheitis, acute laryngitis and other viral diseases, as are some corticosteroids. Therefore, you cannot self-medicate in such a situation. It is better to give the child warm water, tea or milk, and when the doctor arrives, strictly follow his recommendations.

If the doctor notices swelling of the larynx that has begun, he will require immediate hospitalization of the child. This condition is fraught with the development of asphyxia, so sometimes, to make breathing easier, children undergo a small operation, which consists of cutting the trachea and inserting a special tube into the lumen. This will ensure the baby gets air into the lungs and prevent death.

Conservative treatment is possible in the initial stages of the disease. In case of true croup, the child is administered anti-diphtheria serum according to the Bezredko method. As for antibiotics, erythromycin or penicillin drugs can be used for croup, playing an auxiliary role in treatment. In the treatment of false croup, antihistamines, adrenaline solution, glucocorticosteroids, and inhalation of saline are used.

Croup in children under one year of age: emergency care

It should be noted that attacks of croup in a one-year-old child and children under one year old usually appear in the evening and at night. The baby becomes restless, pulls down the collar of his pajamas, and tosses and turns. An attack of dry cough occurs, the child breathes noisily and heavily. With massive swelling of the larynx, signs of oxygen deficiency appear: lethargy, pale skin, bluish lips, confusion and loss of consciousness. In such a situation, you must adhere to the following algorithm of actions:

Call an ambulance.
Before the doctors arrive, try to calm the baby, as crying and overexcitement worsen the cough.
Place the child in bed on a pillow so that the upper body is elevated.
Give him a warm alkaline drink (milk with Borjomi or 2% soda solution) - this will thin the phlegm and moisturize the mucous membranes. You can also do inhalation with saline solution or mineral water. A nebulizer works well for this.
Open a window in the room where the child is, humidify the air with a humidifier or hang wet towels. You can take the baby out to the balcony, wrapping it in a blanket.
Drop any vasoconstrictor drops into the nasal passages or let them breathe the solution through a nebulizer.
You can give your baby in age-appropriate dosages: antihistamines (Fenistil, Eden) to relieve swelling of the mucous membrane; No-shpu to reduce laryngeal spasm; antipyretic drugs (Nurofen, Panadol) for fever.

We draw your attention to what you absolutely cannot do during an attack of croup in children:

give antitussive drugs without a doctor’s prescription;
put mustard plasters, carry out rubbing;
use homemade inhalers;
give allergic foods - citrus fruits, honey, raspberry jam.

Do not leave the baby alone in the room, stay close to him at all times, and when the ambulance arrives, follow all the doctors’ instructions. Then everything will be fine!

Viral croup in a child: Komarovsky

The famous pediatrician - Evgeny Borisovich Komarovsky - in his television programs talks in detail about how to distinguish ordinary laryngitis from viral croup in children, and what to do in such a situation.

So, laryngitis is a complication of a viral infection that occurs in the larynx in the place where the vocal cords are located. But inflammation of the larynx can be so severe that its lumen becomes much narrower. When a narrowing of the larynx occurs due to infectious diseases, this condition is called croup. That is, croup differs from laryngitis in that in the first version there is a narrowing of the larynx and, therefore, difficulty breathing, but with laryngitis this does not happen. However, any viral infection in the respiratory tract should alert the pediatrician, since the accumulation of mucus at night can lead to the development of croup. That is why, in case of laryngitis and other infectious diseases of the upper respiratory tract, it is necessary to regularly moisten the baby’s room (ventilation, wet cleaning) in order to prevent the accumulation of mucus and narrowing of the larynx. If croup does appear, then in such a situation it is necessary to provide the child with first aid in a timely manner.

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Symptoms, treatment and prevention of croup in children

Croup is not an independent disease and is a syndrome that accompanies various respiratory diseases.

In pediatrics, this condition is not uncommon. When an infection occurs, a child experiences spasm of the laryngeal muscles and narrowing of the lumen of the larynx.

The lack of timely diagnosis and proper treatment can cause serious complications that threaten the baby’s life. We will talk about the symptoms and treatment of croup in children in the article.

Concept and features

Croup is a syndrome that is provoked by infectious and inflammatory diseases of the upper respiratory tract.

In this condition, swelling of the mucous membranes of the larynx and narrowing of its lumen occurs.

Croup always manifests itself in the form of a characteristic cough in combination with additional symptoms.

In a broad sense, this syndrome is an inflammation of the larynx or a consequence of laryngitis.

croup can be true or false (in the first case, the disease develops against the background of diphtheria, in the second it is provoked by diseases of other categories);
in otolaryngology, croup has a second name - stenosing laryngitis;
Children from three months to five years old are at risk;
croup can be a complication of tracheitis or bronchitis.

Causes

Certain types of bacteria and viruses can provoke the development of croup. In rare cases, the pathological process has a fungal etiology. Infectious agents enter the child’s body primarily through airborne droplets.

The child's weakened immune system and the presence of concomitant diseases increases the risk of developing croup.

The tendency to this syndrome increases in the presence of factors such as birth injuries to the baby, fetal hypoxia, the development of rickets or the presence of chronic respiratory diseases.

The causes of croup in children are complications of the following diseases:

Symptoms and signs

Some symptoms of croup are common and appear regardless of the stage or etiology of the infectious process.

The main symptom of the syndrome is a characteristic “barking” cough, indicating a disruption in the supply of oxygen to the lungs.

The presence of this symptom is a reason to immediately consult a doctor. Croup can develop at a rapid pace and within a short period of time the lumen of the child’s larynx will narrow to critical levels.

Symptoms of croup in children include the following:

voice dysphonia;
swelling of the mucous membranes of the larynx;
"barking" or "wheezing" cough;
difficulty breathing;
increased body temperature;
noisy breathing;
difficulty swallowing;
inspiratory dyspnea;
symptoms of body intoxication;
restlessness or lethargy;
increased salivation;
pale skin;
signs of tachycardia;
dyspnea;
headache;
significant decrease in appetite;
blue tint of lips and nails;
increased fatigue;
general sluggish state of the body.

Forms and stages

Croup is a combination of several pathological processes. First, swelling of the larynx develops, provoking a reflex contraction of its muscles. Then a significant amount of mucus and sputum accumulates in the lumen.

The consequence of such processes is stenosis of the larynx. When you inhale air, less oxygen reaches your lungs. In the absence of timely treatment, there is a risk of complete blockage of the lumen of the larynx and death of the small patient.

due to the occurrence of croup, it can be bacterial, viral or fungal;
according to etiology, the syndrome is further divided into spasmodic and croup with stridor (in the first case, the pathological process is accompanied by spasms, in the second - noisy breathing);
true and false croup (differences in the progression of symptoms);
true croup develops in three stages - catarrhal, stenotic and asphyxial stage;
false croup progresses in four stages - compensated, subcompensated, decompensated stenosis and the terminal stage of development of the syndrome.

How to treat whooping cough in children? Find out about this from our article.

Could there be complications?

The main and most dangerous complication of croup is the death of the child. The risk of such a condition may arise if the baby is treated incorrectly or untimely.

If a child’s cough does not go away for a long time, does not reduce its symptoms when using medications, or has acquired a “barking” character, it is necessary to immediately contact a medical institution for a comprehensive examination of the baby.

The following conditions can cause complications of croup:

How to confirm the diagnosis?

A pediatrician or otolaryngologist can diagnose croup in a child. In some cases, a consultation with a pulmonologist may be necessary to assess complications of bronchopulmonary disease.

If diagnosis is difficult, doctors give referrals to other specialized specialists. Confirmation of the diagnosis is carried out on the basis of a visual examination of the child, the collected medical history, data from laboratory and instrumental studies.

When diagnosing croup in children, the following procedures are used:

laryngoscopy;
otoscopy;
lumbar puncture;
PCR research;
auscultation of the lungs;
blood gas analysis;
serological studies;
ELISA and RIF diagnostics;
X-ray of the lungs;
general blood and urine analysis;
bacterial culture of throat swabs;
pharyngoscopy;
X-ray of the paranasal sinuses and larynx;
biochemical analysis of blood and urine.

Treatment

When croup is diagnosed, the child must be admitted to a hospital (infectious diseases department).

Treatment methods for the syndrome depend not only on the age and individual characteristics of the baby’s body, but also on the degree of progression of the pathological process.

Most procedures are performed by intravenous or intramuscular injection.

In this case, anti-diphtheria solutions, glucose, glucocorticosteroids and other drugs can be used. After discharge, the child is prescribed medications for symptomatic treatment.

Drugs

The list of drugs necessary for the treatment of croup depends on the clinical picture of the child’s health condition and the tendency to recovery after hospital stay.

Only a specialist should make a list of medications. Cough with croup has some features and requires complex treatment with certain types of medications.

Incorrect selection will reduce the effectiveness of therapy and increase the risk of complications.

The following medications can be used for croup:

antiviral agents (Proteflazid, Interferon);
means to eliminate laryngeal edema (Epinephrine);
drugs to eliminate spasm of the laryngeal muscles (Salbutamol);
broad-spectrum antispasmodics (Baralgin);
drugs from the mucolytic group (Ambroxol, Carbocysteine).

Inhalations

You can use the inhalation method for croup in a child only after a full examination of the baby and consultation with a specialist.

If there is an elevated body temperature, such procedures are strictly prohibited.

If the doctor approves of inhalations, then they can be carried out using the steam method or using a nebulizer.

In the first case, the child needs to breathe in the steam of decoctions based on medicinal herbs (chamomile, calendula, St. John's wort), Furacilin solution or baking soda. For the nebulizer, you can use special oil and alkaline liquids.

Folk remedies

Alternative medicine recipes can be used as an addition to the main therapy for croup, but they cannot be used as independent remedies.

Examples of folk remedies:

Saline solution to prevent blockage of the nasal passages (dilute a teaspoon of salt in one glass of water, instill the product several times a day into each nasal passage, one or two drops).
A medicinal mixture for gargling (combine three parts of oak bark, sage leaves and one part of fennel in one container, place a tablespoon of the resulting mixture in a thermos and pour boiling water, use the gargle several times a day).
Gargling with peppermint solution (pour one teaspoon of the dry mixture with a glass of boiling water, after infusing and cooling, use the product to gargle or irrigate the throat several times a day).

The doctor clearly explains how to distinguish laryngitis from a dangerous syndrome.

In the first case, an inflammatory process develops, which only leads to a narrowing of the larynx, in the second, the lumen narrows to a critical state. Croup is a consequence of laryngitis.

If you have croup, you should never use antitussive medications on your own.
Therapy of the syndrome should be accompanied by additional preventive measures (wet cleaning of the room, ventilation of the room, etc.).
Croup can be provoked by incorrect actions of parents in the treatment of acute respiratory infections or acute respiratory viral infections (for example, it is strictly forbidden to use drugs and folk remedies for such diseases that have the ability to provoke swelling of the larynx - honey, mustard plasters, improper inhalations, etc.).
During the period of infection, it is necessary to actively strengthen the baby’s immunity (with diet or special medications).
Antibiotics are used in the treatment of the syndrome only in rare cases (this category of drugs is characterized by low effectiveness in treating croup and only helps get rid of secondary infections).

Forecast

Prognosis for croup directly depends on the individual characteristics of the child’s body, the level of its protective functions and timely measures taken to treat the syndrome.

If all doctors’ recommendations are followed, complications may not arise. Otherwise, there is a risk of the child developing severe pathological processes in the respiratory organs (pneumonia) or chronic diseases (bronchitis).

Prevention

The main measure to prevent croup is the timely treatment of diseases that can provoke this syndrome.

If the symptoms of such pathological processes do not go away for a long time, then there is a need for a mandatory re-examination of the baby by a specialist.

Parents should pay attention to strengthening the child’s immunity from the first days of his life.

Prevention of croup in children includes the following recommendations:

control of the baby’s nutrition at any age (balanced diet);
complete and timely treatment of any diseases;
timely contact with specialists to diagnose existing violations of internal systems;
excluding self-medication for coughs (wet or dry coughs require different methods of therapy);
timely implementation of mandatory vaccinations (scheduled vaccinations).

Fatal outcomes due to croup in medical practice are isolated cases.

If the syndrome is not fully cured, there is a risk of developing chronic respiratory diseases and secondary infections.

In addition, croup is a dangerous condition that occurs most of the time at night and suddenly. An attack is a reason to call an ambulance.

Dr. Komarovsky about the treatment of croup in children in this video:

Treatment of false croup in children according to E.O. Komarovsky

Children aged six months to six years are often diagnosed with acute laryngitis. As the disease develops, inflammation may occur, leading to a narrowing of the larynx, which causes difficulty breathing. This type of laryngitis is called stenotic laryngitis and can be caused by allergies, pharyngeal injuries, and infections. Stenosing laryngitis caused by a viral infection is called false croup. Thanks to vaccination, true croup, caused by a bacterial infection (diphtheria), is now very rare.

Reasons

False croup most often occurs with acute respiratory viral infections caused by the parainfluenza virus. It is at the age of six months (when the immunity transmitted to the child from the mother weakens) and up to two years that the child’s body first encounters this virus. Also, the cause of acute stenosing laryngitis can be rhinovirus, influenza virus, respiratory syncytial virus.

It should be noted that false croup is extremely rare in adults. The decisive role in this case is played not so much by the greater maturity of the immune system in adults compared to children, but by the anatomical features of the structure of the nasopharynx organs.

The structure of the larynx in a child creates favorable conditions for the development of stenosis:

soft, pliable cartilaginous skeleton;
small size of the larynx (the diameter of the larynx in children is several times smaller compared to adults, while the sizes of the epithelial cells are the same);
short and narrowed vestibule of the pharynx;
high vocal cords;
the mucous membrane of the pharynx is rich in cellular elements;
a large number of blood vessels in the submucosal layer of the larynx.

Famous doctor E.O. Komarovsky also notes that all children at an early age have increased reflex excitability of the adductor muscles, which are responsible for closing the glottis, as well as immaturity of the reflexogenic areas of the larynx, which is also a factor provoking the development of the disease.

Symptoms

Most often, the occurrence of false croup is preceded by the development of a viral infection. Therefore, at the initial stage of the disease, symptoms characteristic of the common cold are characteristic: runny nose, malaise, fever, sore throat. If the infection is the cause of false croup, then the above symptoms are added to:

hoarseness, severe hoarseness of voice, even loss of voice;
dry, annoying, barking cough;
noisy, labored breathing, the child experiences difficulty in inhaling air due to swelling in the larynx;
blue lips, nasolabial triangle, pale skin;

Important! In later stages, edema develops with a sharp decrease in the gap in the larynx; signs of hypoxia, loss of consciousness, and suffocation may appear.

Most often, attacks of false croup occur at night, when the child is sleeping. Experts attribute this phenomenon to several factors:

increased tone of the parasympathetic nervous system in childhood, which increases at night, provoking increased secretion and increased contractile activity of the muscles of the trachea and bronchi;
horizontal position, which impairs the drainage ability of the lungs.

Komarovsky also focuses on the so-called “social” reasons for the development of nocturnal attacks of croup. After all, often in the room where the child sleeps, the air temperature is greatly increased, as a result of which the humidity is reduced. The air temperature in the room should be at the level of degrees, humidity - not lower than 50%. If a child has an acute respiratory infection, the recommended humidity in the room should be about 70% and the temperature should not exceed 18 degrees.

The duration of night attacks with false croup is usually about half an hour, after which the child falls asleep again. A characteristic sign of false croup is periodic repetition of attacks.

The occurrence of difficult noisy breathing with stenotic laryngotracheitis is due to a significant narrowing of the lumen in the larynx and a sharp increase in the amount of sputum produced. The volume of breathing directly depends on the severity of the disease. Also, during the development of pathology, the body attempts to compensate for the lack of inhaled volume by increasing the number of breaths taken - shortness of breath develops.

Stages of development

False croup is a serious disease that requires timely treatment. Each child experiences croup differently and has varying degrees of severity. Depending on the stage of stenosis, different treatment methods are required.

The first stage of stenosis is compensated stenosis. In this case, all the characteristic signs of stenosing laryngitis appear: restlessness, noisy, rapid breathing, shortness of breath when inhaling. However, at this stage the patient does not experience a lack of oxygen, so the general condition remains satisfactory. This stage of development of the disease can last from several hours to a couple of days, and with proper treatment does not require hospitalization.
The second stage of stenosis is called subcompensated. In this case, the main symptoms of false croup intensify: breathing can be heard from a distance, difficulty breathing even at rest, constant shortness of breath when inhaling. The work of the muscles of the respiratory apparatus also increases to compensate for the manifestation of stenosis, strong excitement is observed, the skin turns pale, the area of the nasolabial triangle becomes blue, and the heartbeat increases. At this stage, stenosis can last up to five days and can be either constant or consist of individual attacks.
The third stage of the disease is decompensated stenosis. This is a late stage of the disease, requiring immediate hospitalization. Characteristic manifestations: severe respiratory distress, a sharp increase in the functions of the muscles of the respiratory apparatus, the work of which is often not enough to compensate for breathing, therefore, an increase in the amount of carbon dioxide, which provokes drowsiness and severe hoarseness. As for coughing, as stenosis develops, it becomes less pronounced, superficial, and quiet. Shortness of breath occurs during inhalation and exhalation, breathing is irregular, and there are uncharacteristic movements of the ribs and diaphragm.
The fourth stage of stenosis is asphyxia (extreme stage). This is the very last stage of the disease, in which the child falls into a coma, the condition is often accompanied by convulsions, a sharp drop in body temperature (can often drop below 36.6 degrees). Breathing in the extreme stage of stenosis is very frequent and shallow. At this stage, it is necessary to carry out a set of resuscitation measures to restore breathing and deliver oxygen to the lungs.

Important! Despite the fact that there are four stages of the disease, false croup can develop from the initial stage to asphyxia within just one day.

Diagnostics

Making a diagnosis of false croup is often not difficult, since the disease has a characteristic clinical picture. At the first stage, it is important to exclude the presence of true croup, since this disease is more dangerous and requires special treatment. This is done using a smear to determine the presence of Loeffler's bacillus (BL test).

The following are used as diagnostic procedures for false croup:

general examination by a doctor, preliminary assessment of the condition of the larynx;
a smear to assess the type of infection that caused the disease;
blood test to determine the nature of inflammation;
laryngoscopy to assess the degree of stenosis;
pulse oximetry to detect the presence of hypoxia and determine its degree;
methods for assessing blood gas composition.

In the diagnostic process, it is important to differentiate false croup from other causes that can cause similar symptoms: the presence of a foreign object, tumors, retropharyngeal abscess, and other conditions that may interfere with the normal patency of the larynx.

Treatment

In the early stages of the development of the disease, as well as in later stages before the arrival of emergency doctors, parents can independently provide first aid to the child.

The very first thing parents should do is reassure the child. Nervousness leads to tension in the muscles of the larynx, which can further aggravate the patient’s condition.
At the first signs of false croup, it is necessary to facilitate the access of oxygen: remove tight clothes, ventilate the room where the child is. You should also set the optimal humidity (using a humidifier, wet cleaning, water containers) and air temperature (not higher than 18 degrees).
If there is an elevated body temperature, give antipyretic drugs (Paracetamol, Ibuprofen in an appropriate age-appropriate dosage), since as the temperature rises, breathing becomes more frequent, which can aggravate respiratory failure with stenosis.
Many doctors also recommend using distraction treatments for viral croup, such as hot baths for the arms and legs, which promotes blood flow to the extremities. A contraindication in this case is elevated body temperature.

Alkaline inhalations have a pronounced therapeutic effect for false croup. To do this, you can use mineral water Borjomi, Polyana Kvasova, or prepare a solution yourself (a teaspoon of baking soda dissolved in a liter of boiled water). This procedure helps to liquefy accumulated mucus and facilitate its removal, which helps reduce tension in the muscles of the larynx and significantly facilitates the breathing process.
Also, to liquefy and remove viscous secretions, the use of mucolytic and expectorant drugs (ACC, Ambroxol) is indicated.
If for some reason inhalation is not possible, you can give your child alkaline water. In this case, you should use a warm solution, consuming it in small sips, which will reduce the cartilage of the larynx and remove mucus from the respiratory tract.
Drinking plenty of fluids is also indicated for attacks of false croup. The liquid helps to moisturize mucous membranes, dilute viscous secretions, and reduce general intoxication of the body. In this case, it is better to drink warm water or, as Komarovsky recommends, dried fruit compote. You should exclude carbonated drinks, milk, and juices, which can cause an additional allergic reaction.
In emergency situations, accumulated mucus can be removed using artificially induced vomiting.
To reduce the severity of edema, appropriate medications should be used: antihistamines (Zodak, Suprastin, Diazolin), inhalations with vasoconstrictor drops (Nazivin) or simply dripping them into the nose, inhalations using hormonal drugs (Prednisolone, Dexamethasone).
Drugs belonging to the class of diuretics (Furosemide) also help remove excess fluid from the body and reduce swelling.
To reduce the tone of the muscles of the nasopharynx, antispasmodics are used, for example, No-shpu, Papaverine.

Once the doctor determines the cause of the disease that caused false croup, treatment may be required to combat the infection. So, if the disease is caused by a virus, and in the case of false croup this is most often the case, symptomatic treatment should be accompanied by taking antiviral drugs (Groprinosin, Amizon); if the cause is a bacterial infection, then treatment is carried out using antibiotics (Augmentin, Sumamed).

In extremely difficult situations, when there is a threat of suffocation, emergency methods of restoring airway patency are used: intubation (insertion of a special tube into the larynx and trachea) or tracheostomy (insertion of a cannula into the trachea or suturing the tracheal wall to the skin).

Prevention according to Komarovsky

Any disease is better prevented. Therefore, it is necessary to pay attention to the prevention of false croup. At the first signs of any viral disease or cold, Komarovsky recommends following three basic rules:

Do not feed the child until he asks for it.
Drink plenty of fluids; the best option is dried fruit compote.
Provide clean, cool, moist air indoors, increase the duration of walks in the fresh air.

Also effective in preventing false croup and other viral infections is cleanliness in the house and proper arrangement of the children's room, where there should be no carpets, a large number of books and soft toys - things in which dust accumulates. In order to moisturize the nasopharyngeal mucosa, it is recommended to rinse the nose with saline solution.

An acute inflammatory process in the respiratory tract, accompanied by swelling and narrowing of the larynx, is called stenosing laryngotracheitis or otherwise false croup. The severity of the disease is characterized by the degree of narrowing of the larynx and reaches its peak at night when the baby is sleeping.

False croup in children is characterized by the following triad of symptoms:

dry, loud and continuous cough, called croaking or barking;
difficult, noisy breathing, shortness of breath, caused by a narrowing of the lumen of the larynx, through which air enters the lungs;
hoarse, rough voice.

False croup occurs not as an independent disease, but as a consequence of infectious diseases. Therefore, it is often accompanied by elevated body temperature. Depending on the causative agent of the disease, its indicator varies from 37 to 40 degrees Celsius.

The disease may be accompanied by enlarged lymph nodes, pain in the throat and when swallowing. The child is agitated and restless, and lacks appetite.

Symptoms of false croup in children vary depending on the degree of narrowing of the larynx. There are four degrees of development of stenosis:

Stage 1 - compensated. Breathing is difficult only during physical activity or excitement of the child. When listening to breathing, wheezing is heard as single, mainly during inspiration. There are no signs of hypoxemia. The duration of grade 1 stenosis is from one to two days. The body compensates for breathing difficulties and the blood gas composition remains normal.
Stage 2 - subcompensated. Symptoms characteristic of false croup intensify. Inspiratory shortness of breath becomes constant. The baby's noisy breathing can be heard from a distance. The body compensates for the supply of oxygen through the respiratory muscles, increasing its work. Additional signs of the disease appear: cyanosis around the mouth, pale skin, agitation and restlessness of the child. Tachycardia is noted during coughing attacks. The duration of stage 2 is 3-5 days.
Stage 3 - decompensated. Increased work of the respiratory muscles cannot compensate for the lack of breathing. Blood circulation is impaired, hypoxemia, hypercapnia and hypoxia may develop. The previously restless state is replaced by lethargy and lethargy. The pulse quickens. Breathing becomes arrhythmic, frequent and shallow due to severe narrowing of the larynx. The cough is weak and quiet. As oxygen deprivation increases, the skin becomes blue. The general condition is assessed as serious.
Stage 4 - asphyxia (suffocation). Breathing becomes barely audible, coughing practically stops. Deep combined acidosis develops. Hypoxemia and hypercapnia are expressed to extreme levels. The child falls into a coma. The condition is assessed as extremely serious. A fatal outcome cannot be ruled out.

At stages 1 and 2, symptomatic drug treatment is carried out. At stages 3 and 4, hospitalization is required. Surgery may be required.

What to do if a child has false croup?

How to relieve an attack of false croup in a child?

It is necessary to remove clothing from the child that is constricting the chest. If he is lying down, raise him to a semi-sitting position.
Give a warm alkaline liquid to drink to soothe an irritated throat and reduce coughing. Warmed milk with added soda or warm mineral water without gas are good for this.
Apply mustard plasters to your calves. This will redistribute blood from the larynx to the lower part of the body.
Give antihistamines to reduce swelling. In case of elevated temperature - antipyretics.
If the child begins to choke, try to induce vomiting. This will help stimulate the respiratory center and clear the airways of mucus. To do this, use a teaspoon to lightly press on the root of the tongue.

False croup in children: symptoms and treatment of the disease

The diagnosis of false croup is made by an emergency physician, otolaryngologist or pediatrician. False croup is very easy to diagnose. But in order to find out what caused it, additional examinations may be required.

What is needed for diagnosis:

Collecting anamnesis (against the background of what disease the croup occurred).
Examination of the patient (visual, assessment of breathing patterns, cardiac activity, blood pressure).
Taking a swab from the throat, followed by inoculation on nutrient media to identify the pathogen.
Blood test to study gas composition and acid-base status.
Laryngoscopy to assess the condition of the mucous membranes of the respiratory tract.

The main goal of treating false croup in children is to relieve symptoms of the disease by relieving attacks of stenosis, reducing inflammation and swelling of the larynx. For this, appropriate medications and inhalations are used.

Drug treatment includes the following drugs:

Depending on the symptoms characteristic of each stage of development of false croup in children, appropriate treatment is prescribed.

Stage 1. Plenty of warm drinks, alkaline steam inhalations, antispastic therapy (papaverine, atropine), antihistamines, and vitamins are recommended. If there is no effect, then an intranasal novocaine blockade is performed to reduce laryngeal edema.
Stage 2. To the above drugs are added hormonal (hydrocortisone), cardiac (digoxide, strophanthin), diuretics and antipsychotics (promazine, aminazine).
Stage 3. Cardiac medications and antibiotics are more widely used. If necessary, laryngoscopy and bronchoscopy are performed. As a result of the procedures, mucus, pus, and dry bloody crusts are removed. If these procedures do not help, then more complex ones are performed - intubation and tracheostomy.

Symptoms of false croup in children may coincide with symptoms of other diseases:

True croup. Occurs against the background of diphtheria. It does not develop rapidly, but gradually. A distinctive symptom is a white coating on the tonsils.
Laryngospasm. Arises suddenly, without reason. The child begins to choke and turns blue.
Foreign body of the larynx And. There is no concomitant infectious disease. The cough is spasmodic.
Allergic swelling of the larynx. There is also no infectious nature of the disease. Like false croup, it develops rapidly.

Inhalations are widely used for home treatment. For a child, inhalation with a nebulizer is the best option. In order to moisturize the respiratory tract and reduce swelling, you can use ordinary mineral water. It is poured into a nebulizer, and the child uses a mask to breathe moist air for 10 minutes.

The following remedies effectively relieve symptoms and treat false croup in children:

Berodual (bronchodilator);
flemoclav (antibiotic);
fenistil (antibiotic).

Attention

Steam inhalations should not be used for small children. If you sit a child in front of a hot pan and cover him with a blanket, he may not only get burned, but also get scared. Fear and excitement only intensify the attacks, causing uncontrollable spasms.

If you don’t have a nebulizer, you can use a thermos for inhalation., in which the liquid does not cool down for a long time and there is no need to cover it with anything. Or use a kettle with a kitchen funnel attached to the spout. If you have a cosmetic inhaler, then that will do.

An infant during attacks of false croup should be placed to the breast more often. For older children, avoid hot, cold and spicy foods. Consult your doctor regarding foods that may cause allergies.

One of the important points in treatment is the calm emotional and psychological state of the sick child. Therefore, parents need to keep their baby busy with something that does not require emotional outbursts and physical stress.

Komarovsky about the treatment and symptoms of false croup in children and emergency care before the ambulance arrives

The well-known doctor Komarovsky in Russia believes that in order to cure false croup in children, the symptoms and treatment must correspond to each other. In other words, he speaks out against the widespread use of antibiotics, as well as a host of other drugs, and offers treatment with the appropriate regimen in conditions appropriate for recovery. At the same time, it recognizes that antibiotics should be used in case of bacterial etiology of the disease.

Speaking about hospitalization, Komarovsky draws attention to the fact that if the symptoms of the disease intensify in the evening, then at night it can definitely become even worse. To prevent a serious condition, an ambulance should be called in the evening.

To relieve the symptoms of false croup in children, Komarovsky gives the following recommendations:

strict bed rest;
psychological calm of the child;
fresh air (room ventilation);
humidifying the air in the room (to prevent dryness of the mucous membranes of the larynx);
drinking plenty of fluids (to thin sputum);
alkaline inhalations;
timely use of antitussives.

False croup in children, emergency care for an attack

If a child has a seizure and home treatment does not relieve it within 30 minutes, then you need to call an ambulance. If the condition worsens, you should immediately provide emergency assistance yourself.

What needs to be done?

Causes of false croup in children and prevention of the disease

Most often, the development of false croup occurs due to a common cold. This usually happens in the off-season. The weather in autumn and spring can be deceptive, and a child who is not dressed enough or too warmly catches a cold easily. In addition to acute respiratory infections, there are other diseases of viral etiology, which can also cause false croup in children.

Among them are:

flu;
measles;
rubella;
adenoviral infection;
scarlet fever;
chicken pox.

Along with the infectious nature of the disease, bacterial flora also becomes the cause. It can be activated during ARVI or be attached through infection.

The development of false croup is likely as a result of damage to the larynx by the following bacteria:

staphylococcus;
streptococcus;
Pseudomonas aeruginosa;
coli;
hemophilus influenzae;
enterococcus

How does false croup occur?

A virus or bacteria enters the mucous membrane of the respiratory tract and causes inflammation. There is swelling of the larynx and the formation of excess mucus in the trachea and subglottic space in the area of the vocal cords. Due to the peculiar structure of the respiratory tract and the imperfection of the nervous system that regulates reflex activity, there is a possibility of developing laryngeal stenosis (mainly at night). And what is considered a sore throat for an adult becomes deadly for a small child.

Anatomical factors as the cause of false croup in children:

funnel-shaped larynx;
narrow lumen of the larynx;
high vocal cords;
loose connective and adipose tissue of the subglottic space;
weakness of the respiratory muscles.

Most often, false croup develops in children between 2 and 3 years of age. Rarely occurs in the second half of the first year of life and from 5 to 6 years. Never occurs in infants under 4 months.

Not all children are equally susceptible to stenosing laryngotracheitis.

In addition to the anatomical and physiological features of the structure of the larynx and trachea in childhood, there are other factors that form a risk group:

male gender (they get sick 2 times more often than girls);
narrow airways (congenital stridor);
frequent and prolonged colds;
paratrophy (obesity in children under 3 years of age);
food or drug allergies;
birth injuries.

To exclude laryngotracheitis with the dangerous development of laryngeal stenosis in young children, preventive measures must be taken. What to do to avoid false croup?

Avoid colds:
- exclude the child from communicating with sick people;
- if there is a sick person with an acute respiratory infection in the house, carefully follow the rules of hygiene;
- dress according to the weather;
- provide proper and nutritious nutrition;
- if you often get colds, give vitamins;
- carry out hardening activities.
Treat colds promptly and correctly:
- maintain bed rest;
- frequently ventilate the room and do wet cleaning;
- make sure that the air in the room is not dry;
- give cough medicines in a timely manner;
- do not use essential oils for inhalation;
- do not smoke in the room where the child is.

Prevention of the disease is necessary if the child has had false croup, as relapses are possible.

Reasons

The structure of the larynx in a child creates favorable conditions for the development of stenosis:

soft, pliable cartilaginous skeleton;
small size of the larynx (the diameter of the larynx in children is several times smaller compared to adults, while the sizes of the epithelial cells are the same);
short and narrowed vestibule of the pharynx;
high vocal cords;
the mucous membrane of the pharynx is rich in cellular elements;
a large number of blood vessels in the submucosal layer of the larynx.

Symptoms

Most often, the occurrence of false croup is preceded by the development of a viral infection. Therefore, at the initial stage of the disease, symptoms characteristic of the common cold are characteristic: runny nose, malaise, fever, sore throat. If the infection is the cause of false croup, then the above symptoms are added to:

hoarseness, severe hoarseness of voice, even loss of voice;
dry, annoying, barking cough;
noisy, labored breathing, the child experiences difficulty in inhaling air due to swelling in the larynx;
blue lips, nasolabial triangle, pale skin;

Important! In later stages, edema develops with a sharp decrease in the gap in the larynx; signs of hypoxia, loss of consciousness, and suffocation may appear.

Most often, attacks of false croup occur at night, when the child is sleeping. Experts attribute this phenomenon to several factors:

increased tone of the parasympathetic nervous system in childhood, which increases at night, provoking increased secretion and increased contractile activity of the muscles of the trachea and bronchi;
horizontal position, which impairs the drainage ability of the lungs.

Komarovsky also focuses on the so-called “social” reasons for the development of nocturnal attacks of croup. After all, often in the room where the child sleeps, the air temperature is greatly increased, as a result of which the humidity is reduced. The air temperature in the room should be 18-20 degrees, humidity - not lower than 50%. If a child has an acute respiratory infection, the recommended humidity in the room should be about 70% and the temperature should not exceed 18 degrees.

The duration of night attacks with false croup is usually about half an hour, after which the child falls asleep again. A characteristic sign of false croup is the periodic repetition of attacks.

Stages of development

The first stage of stenosis is compensated stenosis. In this case, all the characteristic signs of stenosing laryngitis appear: restlessness, noisy, rapid breathing, shortness of breath when inhaling. However, at this stage the patient does not experience a lack of oxygen, so the general condition remains satisfactory. This stage of development of the disease can last from several hours to a couple of days, and with proper treatment does not require hospitalization.
The second stage of stenosis is called subcompensated. In this case, the main symptoms of false croup intensify: breathing can be heard from a distance, difficulty breathing even at rest, constant shortness of breath when inhaling. The work of the muscles of the respiratory apparatus also increases to compensate for the manifestation of stenosis, strong excitement is observed, the skin turns pale, the area of the nasolabial triangle becomes blue, and the heartbeat increases. At this stage, stenosis can last up to five days and can be either constant or consist of individual attacks.
The third stage of the disease is decompensated stenosis. This is a late stage of the disease, requiring immediate hospitalization. Characteristic manifestations: severe respiratory distress, a sharp increase in the functions of the muscles of the respiratory apparatus, the work of which is often not enough to compensate for breathing, therefore, an increase in the amount of carbon dioxide, which provokes drowsiness and severe hoarseness. As for coughing, as stenosis develops, it becomes less pronounced, superficial, and quiet. Shortness of breath occurs during inhalation and exhalation, breathing is irregular, and there are uncharacteristic movements of the ribs and diaphragm.
The fourth stage of stenosis is asphyxia (extreme stage). This is the very last stage of the disease, in which the child falls into a coma, the condition is often accompanied by convulsions, a sharp drop in body temperature (can often drop below 36.6 degrees). Breathing in the extreme stage of stenosis is very frequent and shallow. At this stage, it is necessary to carry out a set of resuscitation measures to restore breathing and deliver oxygen to the lungs.

Important! Despite the fact that there are four stages of the disease, false croup can develop from the initial stage to asphyxia within just one day.

Diagnostics

The following are used as diagnostic procedures for false croup:

general examination by a doctor, preliminary assessment of the condition of the larynx;
a smear to assess the type of infection that caused the disease;
blood test to determine the nature of inflammation;
laryngoscopy to assess the degree of stenosis;
pulse oximetry to detect the presence of hypoxia and determine its degree;
methods for assessing blood gas composition.

Treatment

In the early stages of the development of the disease, as well as in later stages before the arrival of emergency doctors, parents can independently provide first aid to the child.

The very first thing parents should do is reassure the child. Nervousness leads to tension in the muscles of the larynx, which can further aggravate the patient’s condition.
At the first signs of false croup, it is necessary to facilitate the access of oxygen: remove tight clothes, ventilate the room where the child is. You should also set the optimal humidity (using a humidifier, wet cleaning, water containers) and air temperature (not higher than 18 degrees).
If there is an elevated body temperature, give antipyretic drugs (Paracetamol, Ibuprofen in an appropriate age-appropriate dosage), since as the temperature rises, breathing becomes more frequent, which can aggravate respiratory failure with stenosis.
Many doctors also recommend using distraction treatments for viral croup, such as hot baths for the arms and legs, which promotes blood flow to the extremities. A contraindication in this case is elevated body temperature.

Prevention according to Komarovsky

Do not feed the child until he asks for it.
Drink plenty of fluids; the best option is dried fruit compote.
Provide clean, cool, moist air indoors, increase the duration of walks in the fresh air.

My son is 5 years old. From the age of 2 we are often worried ARVI With rough barking cough(4-6 times a year in autumn-winter). As a rule, doctors diagnose: " Acute stenosing laryngotracheitis 1-2 tbsp. in the background ARVI". I read a part of the book presented on the Internet, but could not find an answer to the question of whether there are any measures prevention of this disease.

Answers

The situation you described in the most detailed manner, with all the details detailed, is presented in the book, which can be completely downloaded and studied. For a non-medical person this may be difficult, so I’ll note the main points. If it is constantly repeated, and even so often, croup, then this is not only an infection, but also a congenital anatomical feature of the larynx. The child will definitely outgrow this. This cannot be avoided, but it can be significantly alleviated. Those. You can choke, you can breathe noisily, or you can just wheeze for a couple of days, but how it turns out depends on the mother. For any ARVI, cold, malaise, three main rules:
1. Don’t remember about food until asked.
2. Drink in liters, optimally - dried fruit compote.
3. Clean, cool, moist air, maximum exposure to fresh air. There should be nothing in the children's bedroom where dust cannot be wiped off (carpets, books not behind glass, upholstered furniture, etc.).
Preparations: always calcium gluconate 3 tablets. per day; and any lozenges for resorption (Bronchicum or Doctor Mom) - constantly suck. Rinse your nose with saline solution.
Under no circumstances: do not inhale steam, do not steam your legs, God forbid, mustard in any form, do not give drugs such as diphenhydramine, suprastin, tavegil, broncholitin; Antibiotics and any biseptols are contraindicated.

Reasons

The structure of the larynx in a child creates favorable conditions for the development of stenosis:

soft, pliable cartilaginous skeleton;
small size of the larynx (the diameter of the larynx in children is several times smaller compared to adults, while the sizes of the epithelial cells are the same);
short and narrowed vestibule of the pharynx;
high vocal cords;
the mucous membrane of the pharynx is rich in cellular elements;
a large number of blood vessels in the submucosal layer of the larynx.

Symptoms

hoarseness, severe hoarseness of voice, even loss of voice;
dry, annoying, barking cough;
noisy, labored breathing, the child experiences difficulty in inhaling air due to swelling in the larynx;
blue lips, nasolabial triangle, pale skin;

Important! In later stages, edema develops with a sharp decrease in the gap in the larynx; signs of hypoxia, loss of consciousness, and suffocation may appear.

Most often, attacks of false croup occur at night, when the child is sleeping. Experts attribute this phenomenon to several factors:

increased tone of the parasympathetic nervous system in childhood, which increases at night, provoking increased secretion and increased contractile activity of the muscles of the trachea and bronchi;
horizontal position, which impairs the drainage ability of the lungs.

Komarovsky also focuses on the so-called “social” reasons for the development of nocturnal attacks of croup. After all, often in the room where the child sleeps, the air temperature is greatly increased, as a result of which the humidity is reduced. The air temperature in the room should be 18-20 degrees, humidity - not lower than 50%. If a child has an acute respiratory infection, the recommended humidity in the room should be about 70% and the temperature should not exceed 18 degrees.

The duration of night attacks with false croup is usually about half an hour, after which the child falls asleep again. A characteristic sign of false croup is the periodic repetition of attacks.

Stages of development

The first stage of stenosis is compensated stenosis. In this case, all the characteristic signs of stenosing laryngitis appear: restlessness, noisy, rapid breathing, shortness of breath when inhaling. However, at this stage the patient does not experience a lack of oxygen, so the general condition remains satisfactory. This stage of development of the disease can last from several hours to a couple of days, and with proper treatment does not require hospitalization.
The second stage of stenosis is called subcompensated. In this case, the main symptoms of false croup intensify: breathing can be heard from a distance, difficulty breathing even at rest, constant shortness of breath when inhaling. The work of the muscles of the respiratory apparatus also increases to compensate for the manifestation of stenosis, strong excitement is observed, the skin turns pale, the area of the nasolabial triangle becomes blue, and the heartbeat increases. At this stage, stenosis can last up to five days and can be either constant or consist of individual attacks.
The third stage of the disease is decompensated stenosis. This is a late stage of the disease, requiring immediate hospitalization. Characteristic manifestations: severe respiratory distress, a sharp increase in the functions of the muscles of the respiratory apparatus, the work of which is often not enough to compensate for breathing, therefore, an increase in the amount of carbon dioxide, which provokes drowsiness and severe hoarseness. As for coughing, as stenosis develops, it becomes less pronounced, superficial, and quiet. Shortness of breath occurs during inhalation and exhalation, breathing is irregular, and there are uncharacteristic movements of the ribs and diaphragm.
The fourth stage of stenosis is asphyxia (extreme stage). This is the very last stage of the disease, in which the child falls into a coma, the condition is often accompanied by convulsions, a sharp drop in body temperature (can often drop below 36.6 degrees). Breathing in the extreme stage of stenosis is very frequent and shallow. At this stage, it is necessary to carry out a set of resuscitation measures to restore breathing and deliver oxygen to the lungs.

Important! Despite the fact that there are four stages of the disease, false croup can develop from the initial stage to asphyxia within just one day.

Diagnostics

The following are used as diagnostic procedures for false croup:

general examination by a doctor, preliminary assessment of the condition of the larynx;
a smear to assess the type of infection that caused the disease;
blood test to determine the nature of inflammation;
laryngoscopy to assess the degree of stenosis;
pulse oximetry to detect the presence of hypoxia and determine its degree;
methods for assessing blood gas composition.

Treatment

In the early stages of the development of the disease, as well as in later stages before the arrival of emergency doctors, parents can independently provide first aid to the child.

The very first thing parents should do is reassure the child. Nervousness leads to tension in the muscles of the larynx, which can further aggravate the patient’s condition.
At the first signs of false croup, it is necessary to facilitate the access of oxygen: remove tight clothes, ventilate the room where the child is. You should also set the optimal humidity (using a humidifier, wet cleaning, water containers) and air temperature (not higher than 18 degrees).
If there is an elevated body temperature, give antipyretic drugs (Paracetamol, Ibuprofen in an appropriate age-appropriate dosage), since as the temperature rises, breathing becomes more frequent, which can aggravate respiratory failure with stenosis.
Many doctors also recommend using distraction treatments for viral croup, such as hot baths for the arms and legs, which promotes blood flow to the extremities. A contraindication in this case is elevated body temperature.

Prevention according to Komarovsky

Do not feed the child until he asks for it.
Drink plenty of fluids; the best option is dried fruit compote.
Provide clean, cool, moist air indoors, increase the duration of walks in the fresh air.