Croup in children
The content of the article:
- Causes
- Kinds
- Signs of croup in children
-
Diagnostics
Differential diagnosis of true and false croup in children
- Treatment of cereals in children
- Potential consequences and complications
- Forecast
- Prevention
Croup in children (stenosing laryngitis) is a clinical syndrome that arises as a complication of certain infectious and inflammatory diseases of the upper respiratory tract and manifests itself in inspiratory dyspnea, barking cough, and hoarseness.
Source: uzi-center.ru
Croup is most often seen in children under 6 years of age. This is due to the age-related characteristics of the structure of the larynx (loose submucous tissue, cone-shaped) and its innervation.
Causes
Croup in children develops against the background of infectious and inflammatory diseases, accompanied by damage to the mucous membrane of the pharynx and trachea, for example, with influenza, adenovirus infection, measles, scarlet fever, chickenpox, diphtheria.
Airway obstruction with croup develops gradually, in stages and is associated with a direct effect on the mucous membrane of infectious agents and their waste products. Its final stage is asphyxiation.
The pathological mechanism of the development of croup in children is based on the following processes:
- reflex spasm of the muscles that constrict the larynx (constrictors);
- swelling of the inflamed mucous membrane of the larynx;
- hypersecretion of viscous thick mucus.
The obstruction of the airways that occurs with croup in children makes it difficult to inhale, as a result of which insufficient oxygen enters the lungs for normal breathing. In turn, this leads to hypoxia - oxygen starvation of all organs and tissues of the body.
The general condition of children with croup directly depends on the severity of the obstruction. At the initial stages, compensation for the arising difficulty in breathing is carried out due to the more intense work of the respiratory muscles. A further decrease in the lumen of the larynx is accompanied by a compensatory breakdown and the appearance of paradoxical breathing, in which the chest expands on exhalation and narrows on inhalation. The final stage of croup in children is asphyxia, which is fatal.
Kinds
The croup in children, depending on the level of damage to the larynx, is divided into true and false. Croup develops as a result of swelling of the vocal folds (ligaments). The only example of this pathology is diphtheria stenosing laryngitis. With false croup in children, there is an inflammatory edema of the mucous membrane of the subglottic (subglottic) zone of the larynx of non-diphtheria etiology.
According to the etiology of the underlying disease, false croup in children is divided into the following types:
- viral;
- bacterial;
- fungal;
- chlamydial;
- mycoplasma.
According to the severity of obstruction, the following degrees of croup in children are distinguished:
- Compensated stenosis.
- Subcompensated (incomplete compensation) stenosis.
- Decompensated (uncompensated) stenosis.
- Terminal phase (asphyxia).
By the nature of the clinical course of croup in children, it can be uncomplicated and complicated. Complicated is characterized by the addition of a secondary bacterial infection.
Diphtheria, or true croup, according to the prevalence of the inflammatory process, in turn, is subdivided into non-widespread (limited by the vocal cords) and widespread (descending) croup, in which the infectious process affects the trachea, bronchi.
Signs of croup in children
The clinical picture of croup in children includes the following symptoms:
- Noisy breathing (stridor). It is observed with croup of any etiology. The sound accompanying the act of breathing is associated with the vibration of the vocal cords, arytenoid cartilage and the epiglottis. As the stenosis of the larynx increases, the sonority of respiratory sounds decreases, which is associated with a decrease in tidal volume.
- Dyspnea. This is a mandatory symptom of croup in children. With subcompensated stenosing laryngitis, shortness of breath is inspiratory in nature, that is, the child experiences difficulty at the moment of inhalation. The transition of the disease to the decompensated stage is characterized by the appearance of mixed inspiratory-expiratory dyspnea (both inhalation and exhalation are difficult). Increased body temperature and rapid breathing with croup in children are accompanied by a significant loss of fluid with the development of respiratory exsicosis.
- Dysphonia (voice change). The development of this symptom of croup in children is associated with inflammatory changes in the vocal cords. With true croup, the hoarseness of the voice gradually increases until its sonority (aphonia) is completely lost. With a false croup, aphonia never occurs.
- Barking, rough cough. Its occurrence is explained by the incomplete opening of the glottis against the background of spasm. Moreover, the stronger the swelling, the quieter the cough.
Diagnostics
Diagnosis of croup in children does not cause difficulties and is carried out by a pediatrician or otolaryngologist based on the characteristic clinical picture of the disease, anamnesis data, physical examination and laryngoscopy. If necessary, the child is consulted by an infectious disease specialist (diphtheria croup), a phthisiatrician (laryngeal tuberculosis), a pulmonologist (bronchopulmonary complications).
On auscultation of the lungs in children with croup, dry wheezing sounds are heard. The aggravation of the disease is accompanied by the appearance of wet wheezing of various sizes.
During laryngoscopy, the degree of laryngeal stenosis, the prevalence of the pathological process, the presence or absence of fibrinous films are determined.
To verify the pathogen, methods of laboratory diagnostics are used: bacteriological culture and microscopy of smears from the throat, serological studies (RIF, ELISA, PCR). In order to determine the severity of hypoxia, the acid-base state of the blood and its gas composition are determined.
If complications are suspected, according to indications, a lumbar puncture, radiography of the paranasal sinuses and lungs, rhinoscopy, otoscopy, pharyngoscopy are prescribed.
Croup in children requires differential diagnosis with the following diseases:
- laryngeal tumors;
- bronchial asthma;
- epiglottitis;
- retropharyngeal abscess;
- foreign body of the larynx;
- whooping cough;
- congenital stridor.
Differential diagnosis of diphtheria croup and croup of other etiology:
| Sign | True diphtheria croup | False croup |
| Vote | Increasing hoarseness of voice, turning into persistent aphonia | Hoarseness of voice is fickle, no aphonia |
| Cough | Dry, rough, barking, dull, losing sonority, up to complete aphonia | Rough, barking, not losing sonority |
| Raids | Off-white, difficult to remove, bleeding surface remains after plaque removal | Superficial, easy to remove |
| Cervical lymph nodes | Enlarged, swollen on both sides, slightly painful, swelling of the tissue around the nodes | Enlarged, very painful, no edema. Individual lymph nodes are palpated |
| Development of stenosis | Laryngeal stenosis develops gradually, at first noisy breathing, turning into an attack of suffocation. Does not pass on its own | Stenosis occurs suddenly, more often at night. Inhale is loud, heard in the distance. Sometimes stenosis resolves spontaneously |
Differential diagnosis of true and false croup in children
The first symptoms of both true and false croup in children appear 2-3 days from the onset of the underlying disease. The clinical picture of true croup in children is characterized by a gradual increase in respiratory disorders.
In the course of the disease, several stages are clearly traced:
- Dysphonic. Hoarseness of the voice is noted, there are no signs of obstruction.
- Stenotic. Against the background of increasing obstruction of the larynx, the child develops respiratory disorders, signs of hypoxia appear.
- Asphyxia. Almost complete obstruction of the larynx occurs. Severe hypoxia becomes the cause of the development of hypoxic coma and death.
With false croup in children, an attack occurs suddenly and mainly at night. During the day, the condition of patients changes significantly.
With true croup in children, the vocal cords themselves swell directly, in this regard, the sonority of the voice gradually decreases until complete aphonia (silent crying, screaming). False croup, although accompanied by hoarseness, never develops aphonia. When crying and screaming in children with false croup, the sonority of the voice is preserved.
With true croup in children, during laryngoscopy, swelling and hyperemia of the laryngeal mucosa, a decrease in its lumen, and the presence of diphtheria films are revealed. Diphtheria plaques are removed with difficulty, with the formation of small ulcers under them. The observed laryngoscopic picture with false croup is different. It is characterized by:
- redness and swelling of the mucous membrane;
- accumulation of thick sputum;
- laryngeal stenosis;
- easily removable plaque.
To conduct the final differential diagnosis between false and true croup in children, bacteriological examination of a smear from the pharynx allows. When the diphtheria sticks are isolated from the test material, the diagnosis of true croup is not in doubt.
Treatment of cereals in children
Children with compensated forms of croup are subject to hospitalization in the department of acute respiratory infectious diseases of an infectious diseases hospital. In sub- and decompensated forms, therapy for children should be carried out in specialized emergency departments under the supervision of an otolaryngologist and resuscitator.
Treatment of croup in children is based on the following principles:
- children are placed in wards with an air temperature of no more than 18 ° C;
- with true croup, the administration of antidiphtheria serum is prescribed intravenously or intramuscularly;
- antibiotic therapy - indicated for children with true croup or with false croup, complicated by a bacterial secondary infection;
- inhalation therapy - carried out only for children with a preserved cough reflex;
- the appointment of a short course of glucocorticosteroids (duration 2-3 days);
- antiallergic treatment - antihistamines should be prescribed with extreme caution to children with a pronounced hypersecretory component of inflammation);
- detoxification therapy (intravenous administration of electrolyte solutions, glucose) - is aimed at reducing the severity of intoxication syndrome, correcting water-electrolyte disorders caused by respiratory exicosis;
- with a dry, unproductive cough, antitussive drugs are prescribed, and with a wet cough, mucolytics;
- the appointment of antispasmodics in order to eliminate the reflex spasm of the muscles of the pharyngeal constrictors;
- sedative therapy with pronounced arousal of the child;
- when signs of hypoxia appear, oxygen therapy is performed (inhalation of humidified oxygen through a face mask or nasal catheters, placing the child in an oxygen tent);
- with the ineffectiveness of conservative treatment of croup in children, accompanied by severe respiratory failure, tracheal intubation or tracheostomy is performed.
Source: 17nov.ru
Potential consequences and complications
Croup in children can be complicated by the development of sinusitis, conjunctivitis, otitis media, pneumonia, bronchitis, meningitis.
Forecast
With the timely start of treatment for croup in children, the prognosis is favorable, the disease ends with recovery. In the case of late admission of the child, with the development of severe hypoxia or the addition of complications, the prognosis is serious.
Prevention
Prevention of croup is based on mass vaccination of children against diphtheria in accordance with the national immunization calendar.
Specific prevention of false croup has not been developed. To reduce the risk of its occurrence, it is necessary:
- avoid contact of children with people with signs of acute infectious and inflammatory diseases of the respiratory tract;
- strengthen the body's defenses (adherence to the daily regimen, proper nutrition, regular walks in the fresh air, hardening procedures);
- vaccinate against influenza, measles, mumps, chickenpox.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
