Croup | definition of croup by Medical dictionary Croup | definition of croup by Medical dictionary Related to croup: whooping cough Croup Definition Croup is a common childhood ailment. Typically, it arises from a viral infection of the larynx (voice box) and is associated with mild upper respiratory symptoms such as a runny nose and cough . The key symptom is a harsh barking cough. Croup is usually not serious and most children recover within a few days. In a small percentage of cases, a child develops breathing difficulties and may need medical attention. Description At one time, the term croup was primarily associated with diphtheria , a life-threatening respiratory infection. Owing to widespread vaccinations, diphtheria has become rare in the United States, and croup currently refers to a mild viral infection of the larynx. Croup is also known as laryngotracheitis, a medical term that describes the inflammation of the trachea (windpipe) and larynx. Parainfluenza viruses are the typical root cause of the infection, but influenza (flu) and cold viruses may sometimes be responsible.

All of these viruses are highly contagious and easily transmitted between individuals via sneezing and coughing. Children between the ages of three months and six years are usually affected, with the greatest incidence at one to two years of age. Croup can occur at any time of the year, but it is most typical during early autumn and winter. The characteristic harsh barking of a croupy cough can be very distressing, but it rarely indicates a serious problem. Most children with croup can be treated very effectively at home; however, 1-5% may require medical treatment. Croup may sometimes be confused with more serious conditions, such as epiglottitis or bacterial tracheitis. These ailments arise from bacterial infection and must receive medical treatment. Causes and symptoms The larynx and trachea may become inflamed or swollen from an upper respiratory viral infection. The hallmark sign of croup is a harsh, barking cough. This cough may be preceded by one to three days of symptoms that resemble a slight cold. A croupy cough is often accompanied by a runny nose, hoarseness, and a low fever .

When the child inhales, there may be a raspy or high-pitched noise, called stridor , owing to the narrowed airway and accumulated mucus. In the presence of stridor, medical attention is required. However, the airway rarely narrows so much that breathing is impeded. Symptoms usually go away completely within a few days. Medical treatment may be sought if the child's symptoms do not respond to home treatment. Emergency medical treatment is required immediately if the child has difficulty breathing, swallowing, or talking; develops a high fever (103°F/39.4°C or more); seems unalert or confused; or has pale or blue-tinged skin. Diagnosis Croup is diagnosed based on the symptoms. If symptoms are particularly severe, or do not respond to treatment, an x ray of the throat area is done to assess the possibility of epiglottitis or other blockage of the airway. Treatment Home treatment is the usual method of managing croup symptoms. It is important that the child is kept comfortable and calm to the best degree possible, because crying can make symptoms seem worse. Humid air can help a child with croup feel more comfortable.

Recommended methods include sitting in a steamy bathroom with the hot water running or using a cool-water vaporizer or humidifier. However, research in 2004 found that although cool-mist therapy at home or in the hospital may add to the child's comfort, it does little to treat the actual condition. The child should drink frequently in order to stay well hydrated. To treat any fever, the child may be given an appropriate dose of acetaminophen (like Tylenol). Antihistamines and decongestants are ineffective in treating croup. All children under the age of 18 should not be given aspirin, as it may cause Reye's syndrome, a life-threatening disease of the brain. If the child does not respond to home treatment, medical treatment at a doctor's office or an emergency room could be necessary. Based on the severity of symptoms and the response to treatment, the child may need to be admitted to a hospital. For immediate symptom relief, epinephrine may be administered as an inhaled aerosol. Effects last for up to two hours, but there is a possibility that symptoms may return. For that reason, the child is kept under supervision for three or more hours.

Steroids ( corticosteroids ) such as prednisone may be used to treat croup, particularly if the child has stridor when resting. Of the 1-5% of children requiring medical treatment, approximately 1% need respiratory support. Such support involves intubation (inserting a tube into the trachea) and oxygen administration. Alternative treatment Botanical/herbal medicines can be helpful in healing the cough that is commonly associated with croup. Several herbs to consider for cough treatment include aniseed (Pimpinella anisum), sundew (Drosera rotundifolia), thyme (Thymus vulgaris), and wild cherry bark (Prunus serotina). Homeopathic medicine can be very effective in treating cases of croup. Choosing the correct remedy (a common choice is aconite or monkshood, Aconitum napellus) is always the key to the success of this type of treatment. Prognosis Croup is a temporary condition and children typically recover completely within three to six days. Children can experience one or more episodes of croup during early childhood; however, croup is rarely a dangerous condition.

Prevention Croup is caused by highly transmissible viruses and is often difficult to impossible to prevent. Resources Periodicals Kirn, Timothy F. "Cool Mist Therapy is Losing Credibility for Croup: Steroids or Even Epinephrine May Be Needed." Pediatric News March 2004: 10-11. Key terms Diphtheria — A serious, frequently fatal, bacterial infection that affects the respiratory tract. Vaccinations given in childhood have made diphtheria very rare in the United States. Epiglottitis — A bacterial infection that affects the epiglottis. The epiglottis is a flap of tissue that prevents food and fluid from entering the trachea. The infection causes it to become swollen, potentially blocking the airway. Other symptoms include a high fever, nonbarking cough, muffled voice, and an inability to swallow properly (possibly indicated by drooling). Glucocorticoid — A hormone that helps in digestion of carbohydrates and reduces inflammation. Larynx — Commonly called the voice box, it is the area of the trachea that contains the vocal cords.

Stridor — The medical term used to describe the high-pitched or rasping noise made when air is inhaled. Trachea — Commonly called the windpipe, it is the air pathway that connects the nose and mouth to the lungs. croup [kro̳p] a condition resulting from acute partial obstruction of the upper airway, seen mainly in infants and young children; characteristics include resonant barking cough, hoarseness, and persistent stridor. It may be caused by a viral infection (usually a parainfluenzavirus), a bacterial infection (usually Staphylococcus aureus, Streptococcus pneumoniae, or Streptococcus pyogenes,) an allergy, a foreign body, or a tumor. bacterial croup (membranous croup) (pseudomembranous croup) bacterial tracheitis . croup (krūp), 1. Acute obstruction of upper airway in infants and children characterized by a barking cough with difficult and noisy respiration. 2. Laryngotracheobronchitis in infants and young children caused by parainfluenza viruses 1 and 2. 3.

An anatomic term in veterinary medicine referring to the topline located between the base of the tail and forward to the cranial aspect of the wings of the ilium in dogs and horses. [Scots, probably from A.S. kropan, to cry aloud] croup (krldbomacp) acute partial obstruction of the upper airway, usually in young children and caused by a viral or bacterial infection, allergy, foreign body, or new growth; characteristics include barking cough, hoarseness, and stridor.croup´ouscroup´y bacterial croup , membranous croup, pseudomembranous croup bacterial tracheitis . croup 1 (kro͞op) n. A pathological condition of the larynx, especially in infants and children, that is characterized by respiratory difficulty and a hoarse, brassy cough. croup′ous (kro͞o′pəs), croup′y adj.

croup 2 [kro̅o̅p] Etymology: Scot, to croak an acute infection of the upper and lower respiratory tract that occurs primarily in infants and young children 3 months to 3 years of age after an upper respiratory tract infection. It is characterized by hoarseness; irritability; fever; a distinctive harsh, brassy cough; persistent stridor during inspiration; and dyspnea and tachypnea, resulting from obstruction of the larynx. Cyanosis or pallor occurs in severe cases. The most common causative agents are the parainfluenza viruses, especially type 1, followed by the respiratory syncytial viruses and influenza A and B viruses. Croup can also be caused by bacteria, allergies, and inhaled irritants. Also called acute laryngotracheobronchitis , angina trachealis, exudative angina, laryngostasis . Compare acute epiglottitis . croupous, croupy, adj. observations Transmission occurs through infection with airborne particles or with infected secretions.

Leukocytosis with an increased proportion of polymorphonuclear cells may be present at first, followed by leukopenia and lymphocytosis. A lateral neck x-ray film shows subepiglottic narrowing and a normal-sized epiglottis, which differentiate the condition from acute epiglottitis. Onset of the acute stage is rapid, usually occurs at night, and may be precipitated by exposure to cold air. The child's condition often improves in the morning, but it may worsen at night. interventions Routine treatment consists of bed rest, adequate fluid intake, and alleviation of airway obstruction to ensure adequate respiratory exchange. Children with mild infections are usually managed at home with supportive measures, such as use of acetaminophen to reduce fever and vaporizers, humidifiers, or steam from hot running water in an enclosed bathroom to reduce the spasm of the laryngeal muscles and to free secretions. Hospitalization is indicated for children with dehydration; progressive stridor and respiratory distress; and hypoxia, cyanosis, or pallor. Endotracheal intubation and tracheostomy may be necessary. Humidity and oxygen are usually prescribed.

The vital signs are continuously monitored; changes in pulse and respiration may be early signs of hypoxia and impending airway obstruction. Fluids are often given intravenously to reduce physical exertion and the possibility of vomiting, with its attendant increased risk of aspiration. Corticosteroids and inhaled racemic epinephrine are often used. Other drugs, such as expectorants, bronchodilators, and antihistamines, are rarely used, and sedatives are contraindicated because they exert a depressant effect on the respiratory tract. care considerations The primary focuses of care are to ease breathing by providing humidity and to monitor continuously for signs of respiratory distress and impending airway obstruction, with intubation and tracheostomy equipment kept readily available. To conserve the child's energy and to reduce apprehension, the health care provider encourages rest, disturbs the child as little as possible, remains in attendance, provides comfort with a familiar toy or other device, and encourages parental involvement whenever possible. Fever is usually reduced by the cool atmosphere of the mist tent; antipyretics are given as needed. To prevent chilling, frequent changes of clothing and bed linen are often necessary in the humid environment.

The health care provider also explains the condition to the parents and discusses appropriate care after discharge, including continued use of humidity and ensuring of adequate hydration and proper nutrition. In most children the condition is relatively mild and runs its course in 3 to 7 days. The infection may spread to other areas of the respiratory tract and may cause complications, such as bronchiolitis, pneumonia, and otitis media. The most serious complication is laryngeal obstruction, which may cause death. If a tracheostomy is required, as may happen with a small percentage of children, other complications, such as infection, atelectasis, cannula occlusion, tracheal bleeding, granulation, stenosis, and delayed healing of the stoma, may develop.

croup Acute laryngotracheobronchitis, angina trachealis, laryngostasis Pediatrics A heterogeneous group of acute infections, which cause upper-airway obstruction in children Epidemiology Annual incidence–3/100 children < 6 yrs–US; 1.3% require hospitalization Etiology Parainfluenza type 1, less often type 2 and 3, RSV, influenza virus, rubeola, adenovirus, Mycoplasma pneumoniae Clinical Brassy, seal-like barking or 'croupy' cough accompanied by inspiratory stridor and hoarseness, 2º to intense edema, laryngeal mucus, subglottic stenosis, progressive or episodic dyspnea, tachypnea, cyanosis, sternal and intercostal retractions, dysphagia, low-grade fever, chills, recent URI, ↓ breath sounds, restlessness DiffDx Angioneurotic edema, bacterial tracheitis, epiglottitis, foreign body aspiration, retropharyngeal abscess Management Dexamethasone, prednisolone, budesonide–nebulizer–

effective for croup, mist tents, vaporizers, antibiotics, decongestants, cough suppressants, pain medication, fluids, nebulized racemic epinephrine; hospitalization if stridor at rest (krūp) 1.

Laryngotracheobronchitis in infants and young children caused by parainfluenza viruses 1 and 2. 2. Any infection of the larynx in children, characterized by difficult and noisy respiration and a hoarse cough. [Scots, probably from A.S. kropan, to cry aloud] croup Inflammation and swelling of the main air tubes to the lungs (laryngotracheobronchitis) affecting young children and causing difficult, harsh, noisy and painful breathing and a typical ‘barking’ cough. croup (krōōp), n viral respiratory ailment that afflicts children ages 3 months to 3 years old; symptoms include but are not limited to fever, dry barking cough, dyspnea, and tachypnea. Also called angina trachealis, exudative angina, or laryngostasis. Croup: Background, Epidemiology Epidemiology Overview Background Croup is a common, primarily pediatric viral respiratory tract illness.

As its alternative names, acute laryngotracheitis and acute laryngotracheobronchitis, indicate, croup generally affects the larynx and trachea, although this illness may also extend to the bronchi. This respiratory illness, recognized by physicians for centuries, derives its name from an Anglo-Saxon word, kropan, or from an old Scottish word, roup, meaning to cry out in a hoarse voice. Croup is the most common etiology for hoarseness, cough, and onset of acute stridor in febrile children. Symptoms of coryza may be absent, mild, or marked. The vast majority of children with croup recover without consequences or sequelae; however, it can be life-threatening in young infants. (See Etiology, Epidemiology, Prognosis, Clinical, and Treatment.) Croup manifests as hoarseness, a seal-like barking cough, inspiratory stridor, and a variable degree of respiratory distress. However, morbidity is secondary to narrowing of the larynx and trachea below the level of the glottis (subglottic region), causing the characteristic audible inspiratory stridor (see the image below).

Child with croup. Note the steeple or pencil sign of the proximal trachea evident on this anteroposterior film. Courtesy of Dr. Kelly Marshall, CHOA at Scottish Rite. References Benson BE, Baredes S, Schwartz RA. Stridor. Medscape Reference by WebMD. January 26, 2010. [Full Text] . American Academy of Pediatrics. Parainfluenza Viral Infections. Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003. 479-81. Sung JY, Lee HJ, Eun BW, et al. Role of human coronavirus NL63 in hospitalized children with croup. Pediatr Infect Dis J. 2010 Sep. 29(9):822-6. [Medline] . Williams JV, Harris PA, Tollefson SJ, et al. Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. N Engl J Med.

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2008 Jun. 117(6):464-9. [Medline] . Johnson D. Croup. Clin Evid (Online). 2009 Mar 10. 2009: [Medline] . [Full Text] . [Guideline] Alberta Medical Association. Guideline for the diagnosis and management of croup. Alberta Clinical Practice Guidelines 2005 Update. [Full Text] . Guidelines for the diagnosis and management of croup. 2008 update. Alberta Medical Association. 2011. Chun R, Preciado DA, Zalzal GH, Shah RK. Utility of bronchoscopy for recurrent croup. Ann Otol Rhinol Laryngol. 2009 Jul. 118(7):495-9. [Medline] . Delany DR, Johnston DR. Role of direct laryngoscopy and bronchoscopy in recurrent croup. Otolaryngol Head Neck Surg. 2015 Jan. 152 (1):159-64. [Medline] . Wald EL. Croup: common syndromes and therapy.

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Scolnik D, Coates AL, Stephens D, Da Silva Z, Lavine E, Schuh S. Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial. JAMA. 2006 Mar 15. 295(11):1274-80. [Medline] . Colletti JE. Myth: Cool mist is an effective therapy in the management of croup. CJEM. 2004 Sep. 6(5):357-8. [Medline] . Humidified air inhalation for treating croup [database online]. Cochrane Database of Systematic Reviews; 2006. Bjornson CL, Klassen TP, Williamson J, et al. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med. 2004 Sep 23. 351(13):1306-13. [Medline] . Cetinkaya F, Tufekci BS, Kutluk G.

A comparison of nebulized budesonide, and intramuscular, and oral dexamethasone for treatment of croup. Int J Pediatr Otorhinolaryngol. 2004 Apr. 68(4):453-6. [Medline] . Chub-Uppakarn S, Sangsupawanich P. A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup. Int J Pediatr Otorhinolaryngol. 2007 Mar. 71(3):473-7. [Medline] . Fifoot AA, Ting JY. Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized, double-blinded clinical trial. Emerg Med Australas. 2007 Feb. 19(1):51-8. [Medline] . Russell K, Wiebe N, Saenz A, et al. Glucocorticoids for croup. Cochrane Database Syst Rev. 2004.

CD001955. [Medline] . Zoorob R, Sidani M, Murray J. Croup: an overview. Am Fam Physician. 2011 May 1. 83(9):1067-73. [Medline] . Kairys SW, Olmstead EM, O'Connor GT. Steroid treatment of laryngotracheitis: a meta-analysis of the evidence from randomized trials. Pediatrics. 1989 May. 83(5):683-93. [Medline] . Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP. Glucocorticoids for croup. Cochrane Database Syst Rev. 2011. (1):CD001955. [Medline] . Amir L, Hubermann H, Halevi A, Mor M, Mimouni M, Waisman Y. Oral betamethasone versus intramuscular dexamethasone for the treatment of mild to moderate viral croup: a prospective, randomized trial. Pediatr Emerg Care. 2006 Aug.

22(8):541-4. [Medline] . Geelhoed GC. Budesonide offers no advantage when added to oral dexamethasone in the treatment of croup. Pediatr Emerg Care. 2005 Jun. 21(6):359-62. [Medline] . Sparrow A, Geelhoed G. Prednisolone versus dexamethasone in croup: a randomised equivalence trial. Arch Dis Child. 2006 Jul. 91(7):580-3. [Medline] . [Full Text] . McGee DL, Wald DA, Hinchliffe S. Helium-oxygen therapy in the emergency department. J Emerg Med. 1997 May-Jun. 15(3):291-6. [Medline] . Vorwerk C, Coats TJ. Use of helium-oxygen mixtures in the treatment of croup: a systematic review. Emerg Med J. 2008 Sep. 25(9):547-50. [Medline] . Beckmann KR, Brueggemann WM Jr.

Heliox treatment of severe croup. Am J Emerg Med. 2000 Oct. 18(6):735-6. [Medline] . Terregino CA, Nairn SJ, Chansky ME, Kass JE. The effect of heliox on croup: a pilot study. Acad Emerg Med. 1998 Nov. 5(11):1130-3. [Medline] . Weber JE, Chudnofsky CR, Younger JG, et al. A randomized comparison of helium-oxygen mixture (Heliox) and racemic epinephrine for the treatment of moderate to severe croup. Pediatrics. 2001 Jun. 107(6):E96. [Medline] . Vorwerk C, Coats T. Heliox for croup in children. Cochrane Database Syst Rev. 2010 Feb 17. CD006822. [Medline] . Moraa I, Sturman N, McGuire T, van Driel ML. Heliox for croup in children. Cochrane Database Syst Rev.

2013 Dec 7. 12:CD006822. [Medline] . Dobrovoljac M, Geelhoed GC. 27 years of croup: an update highlighting the effectiveness of 0.15 mg/kg of dexamethasone. Emerg Med Australas. 2009 Aug. 21(4):309-14. [Medline] . Moore M, Little P. Humidified air inhalation for treating croup: a systematic review and meta-analysis. Fam Pract. 2007 Sep. 24(4):295-301. [Medline] . Cruz CI, Patel D. Impacted Button-Battery Masquerading as Croup. J Emerg Med. 2013 Jan 30. [Medline] . Elbuluk O, Shiba T, Shapiro NL. Laryngomalacia presenting as recurrent croup in an infant. Case Rep Otolaryngol. 2013. 2013:649203. [Medline] . [Full Text] .

Ibrahimov M, Yollu U, Akil F, Aydin F, Yener M. Laryngeal foreign body mimicking croup. J Craniofac Surg. 2013 Jan. 24(1):e7-8. [Medline] . Media Gallery Child with croup. Note the steeple or pencil sign of the proximal trachea evident on this anteroposterior film. Courtesy of Dr. Kelly Marshall, CHOA at Scottish Rite. Steeple sign on radiograph. Laryngotracheobronchitis | definition of laryngotracheobronchitis by Medical dictionary Laryngotracheobronchitis | definition of laryngotracheobronchitis by Medical dictionary laryngotracheobronchitis [lah-ring″go-tra″ke-o-brong-ki´tis] inflammation of the larynx, trachea, and bronchi; an acute form is the most common cause of croup .

la·ryn·go·tra·che·o·bron·chi·tis (lă-ring'gō-trā'kē-ō-brong-kī'tis), An acute respiratory infection involving the larynx, trachea, and bronchi. See: croup . laryngotracheobronchitis (LTB) [lering′gōtrā′kē·ō′brong- kī′tis] Etymology: Gk, larynx + L, trachea; Gk, bronchos, windpipe, itis an inflammation of the major respiratory passages, usually causing hoarseness, nonproductive cough, dyspnea, and, in severe cases, significant airway obstruction. Among the causes are infections by coxsackieviruses, echoviruses, Haemophilus influenzae, and Corynebacterium diphtheriae. Treatment usually includes steam inhalations, cough suppressants, and, for bacterial infections, appropriate antibiotics. See also croup .

la·ryn·go·tra·che·o·bron·chi·tis (lă-ring'gō-trā'kē-ō-brong-kī'tis) See: croup laryngotracheobronchitis Widespread inflammation of the voice box ( LARYNX ), the wind-pipe ( TRACHEA ) and the main air passages of the lungs (the BRONCHI ). Laryngotracheobronchitis commonly causes croup, especially in children. Laryngotracheobronchitis (Croup) Description: MEDICAL: Otitis Media and Upper Respiratory Infection Without Major CC Laryngotracheobronchitis (LTB) is an inflammation and obstruction of the larynx, trachea, and major bronchi of children. In small children, the air passages in the lungs are smaller than those of adults, making them more susceptible to obstruction by edema and spasm. Because of the respiratory distress it causes, LTB is one of the most frightening acute diseases of childhood and is responsible for over 250,000 emergency department visits each year.

LTB is sometimes called croup, although croup can be more specifically described as one of three entities: LTB, laryngitis (inflammation of the larynx), or acute spasmodic laryngitis (obstructive narrowing of the larynx because of viral infection, genetic factors, or emotional distress). Acute spasmodic laryngitis is particularly common in children with allergies and those with a family history of croup. Acute LTB usually occurs in the fall or winter in North America and is often mild, self-limiting, and followed by complete recovery. Causes More than 85% of LTB cases are caused by a virus. Parainfluenza 1, 2, and 3 viruses; respiratory syncytial virus; Mycoplasma pneumoniae; and rhinoviruses are the most common causes. The measles virus or bacterial infections such as pertussis and diphtheria are occasionally the cause. Epiglottitis, a life-threatening emergency caused by acute inflammation of the epiglottis and surrounding area, differs from LTB because it usually results from infection with the bacteria Haemophilus influenzae type B.

Another rare occurrence is subglottic hemangioma, which can initially produce symptoms of croup. Recurrent croup may be associated with gastroesophageal reflux disease (GERD). Genetic considerations Although some anatomical structural anomalies have been associated with an increased incidence of croup, no direct genetic link has been made. Gender, ethnic/racial, and life span considerations Children susceptible to LTB are generally between the ages of 3 months and 4 years, with peak incidence from 6 months to 3 years. The susceptibility decreases with age, although some children seem more prone to repeat episodes of LTB. Acute spasmodic laryngitis occurs in the same age group and peaks at age 18 months. As with many respiratory diseases, boys younger than 6 months are affected more often than girls, but in older children, the male-to-female ratio is equal. Croup is more common in white, European American children than in black, African American children. Global health considerations Epiglottitis usually results from infection with the bacteria H. influenzae type B. This condition is more prevalent in developing nations that do not vaccinate for influenzae type B.

Generally, children contract the illness during the cool months in their climate. Assessment History The child usually has a history of an upper respiratory infection and a runny nose (rhinorrhea). The child may have dysphonia (impairment in the ability to make vocal sounds). After 12 to 48 hours of respiratory symptoms, such as cough and increased respiratory rate, the child develops a barking, seal-like cough; a hoarse cry; and inspiratory stridor. The symptoms tend to occur in the late evening and improve during the day, which may be due to the lower cortisol levels at night. The initial sign of LTB is increasing respiratory distress. The child may develop flaring of the nares, a prolonged expiratory phase, and use of accessory muscles. When you auscultate the child’s lungs, the breath sounds may be diminished and you may hear inspiratory stridor. The child may have a mild fever. Increasing respiratory obstruction is indicated by any of the following: increasing stridor, suprasternal and intercostal retractions, respiratory rate above 60, tachycardia, cyanosis, pallor, and restlessness.

Assessment is done using the Westley scale, which evaluates the severity of symptoms based on five factors: (1) stridor, (2) retractions, (3) air entry, (4) cyanosis, and (5) level of consciousness. In addition, each type of croup can have particular symptoms, as shown in Table 1. The course of the infection lasts several days to several weeks, although 60% resolve within 48 hours. Some children may have a lingering, barking cough. A child may have LTB more than once but will outgrow it as the size of the airway increases.

Physical examination SYMPTOMS LTB Fever, breathing problems at night, inability to breathe out because of bronchial edema, decreased breath sounds, expiratory rhonchi, scattered crackles Laryngitis Mild respiratory distress in children, increased respiratory distress in infants; sore throat and cough, inspiratory stridor, dyspnea; late phases: severe dyspnea, fatigue, exhaustion Acute spasmodic laryngitis Hoarseness, rhinorrhea, cough, noisy inspiratory phase that worsens at night, anxiety, labored breathing, cyanosis, rapid pulse; the most severe symptoms may occur on the first night, with lessening symptoms on each of the following nights Psychosocial The parents and child will be apprehensive. Assess the parents’ ability to cope with the emergency situation, and intervene as appropriate. Note that many children are treated at home rather than in the hospital; your teaching plan may need to consider home rather than hospital management. Diagnostic highlights General Comments: Most children require no diagnostic testing and can be diagnosed by the history and physical. If diagnostic testing is needed, it involves identifying the causative organism, determining oxygenation status, and ruling out masses as a cause of obstruction.

Test Type of antibiotic depends on the causative organism Fight bacterial infections Independent Ongoing, continuous observation of the patency of the child’s airway is essential to identify impending obstruction. Prop infants up on pillows or place them in an infant seat; older children should have the head of the bed elevated so that they are in Fowler’s position. Sore throat pain can be decreased by soothing preparations such as iced pops or fruit sherbet. If the child has difficulty swallowing, avoid thick milkshakes. Children should be allowed to rest as much as possible to conserve their energy; organize your interventions to limit disturbances. Provide age-appropriate activities. Crying increases the child’s difficulty in breathing and should be limited if possible by comfort measures and the presence of the parents; parents should be allowed to hold and comfort the child as much as possible. Children sense anxiety from their parents; if you support the parents in dealing with their anxiety and fear, the children are less fearful. A child’s anxiety and agitation will most likely exacerbate the symptoms and need to be avoided if possible. Carefully explaining all procedures and allowing the parents to participate in the care of the child as much as possible help relieve the anxieties of both child and parents.

Provide adequate hydration to liquefy secretions and to replace fluid loss from increased sensible loss (increased respirations and fever). The child also might have a decreased fluid intake during the illness. Clear liquids should be offered frequently. Apply lubricant or ointment around the child’s mouth and lips to decrease the irritation from secretions and mouth breathing. Evidence-Based Practice and Health Policy Tibballs, J., & Watson, T. (2011). Symptoms and signs differentiating croup and epiglottitis. Journal of Paediatrics and Child Health, 47(3), 77–82. In a prospective study that included 203 children who were admitted to an intensive care unit with acute upper airway obstruction, misdiagnoses occurred in 54% prior to a definitive diagnosis of either croup (102 children) or epiglottitis (101 children). Both illnesses presented with stridor; however, children with croup were more likely to present with coughing (p < 0.001), breathing difficulty (p = 0.029), and noisy breathing (p = 0.018).

Children with epiglottitis were more likely to present with drooling (p < 0.001), fever (p = 0.012), dysphonia (p < 0.001), preference to sit (p < 0.001), refusal of food (p < 0.001), dysphagia (p < 0.001), sore throat (p < 0.001), and vomiting (p < 0.001). Coughing had a sensitivity of 100% (95% CI, 96% to 100%) in identifying croup and 98% (95% CI, 93% to 99%) specificity in ruling out epiglottitis. Drooling had a sensitivity of 79% (95% CI, 70% to 86%) in predicting epiglottitis and a specificity of 94% (95% CI, 88% to 97%) in ruling out croup. Documentation guidelines

Question: What is another name for the childhood disease called laryngotracheobronchitis?
Answer: Croup