Symptoms and treatment of false croup in children

None of the children are immune from such a serious complication as false croup. Syndrome with stenosis (narrowing) of the larynx can occur suddenly against the background of any viral disease, severe colds and even allergies. How and why false croup develops and how to provide the child with the necessary help, we will tell in this material.

What it is?

Croup can develop as a complication during severe inflammation of the larynx. Its occurrence is always closely associated with severe tissue edema, their increase in size, and, as a result, narrowing of the larynx in the narrowest place - in the region of the vocal cords.

True croup is swelling and difficulty in breathing only in the area of the ligaments, it occurs with diphtheria. False croup is more prevalent and has a greater number of causes. It is less dangerous than the true one, but with untimely treatment or improper assistance, it can also be fatal.

In children, the respiratory organs have certain age differences that contribute to the development of croup. Their airways are loose and narrow, the larynx is smaller than in adults, in size and proportion. As a result, severe edema that accompanies, for example, laryngitis or laryngotracheitis can literally "cut off" the baby's oxygen.

In the risk group for such a complication in ARVI, influenza and other frequent and typical diseases in childhood, - babies from birth to 3 years old. This age accounts for more than half of all reported cases of false croup. After 6-7 years, children are much less likely to undergo such a complication, and after 10 years, the risks are practically reduced to zero.

Causes

Most often, the cause of the development of false croup is the parainfluenza virus, other causative agents of ARVI, influenza, ARI. The most severe forms of complications with stenosis are caused by influenza viruses of strains A and B, and, of course, adenoviruses. Bacteria by themselves rarely cause inflammation and swelling of the larynx and adjacent respiratory system. But they can join as a secondary infection.

Croup develops on its own extremely rarely. In 99.9% of cases, false croup acts as a complication of rhinitis, pharyngitis, laryngitis, chickenpox, scarlet fever, as well as chronic tonsillitis in the acute stage. The weak or weakened immunity of the child, which, due to age and the underlying disease, cannot resist the spread of the inflammatory process, prematurity, rickets, as well as other systemic diseases that the baby may have, can be considered as concomitant factors.

False croup differs from most diseases of the respiratory system in its ability to cause stenosis, in which the larynx is critical, and sometimes completely closed, preventing the child from breathing.

Muscle spasms only increase stenosis. And the mucus, which is actively produced by the mucous membranes during the inflammatory process, "complement" this alarming picture and create an additional obstacle to the passage of air into the lower respiratory tract.

False croup can develop in stages, or it can stop at one of the stages and start reverse development. At the initial stage, obstructive syndrome causes slight oxygen starvation, but the child's body, which knows how to compensate for everything, gives depth and saturation to breathing and, as it can, compensates for the state.

If the edema increases and the stenosis becomes more pronounced, the stage of decompensation will come. Oxygen deficiency will “hit” the cardiovascular system, kidneys and brain. This can cause serious consequences, including asphyxia or death from cardiovascular failure.

Kinds

False croup caused by inflammation of a viral origin will be called viral, and if the stenosis is a consequence of bacterial infection, then the croup will be called bacterial.

However, information about the pathogen will be secondary, in the first place the doctor will put other information - what type of croup the child has in terms of the degree of complexity and severity of stenosis.

On this basis, false croup happens:

First degree. This is a compensated stenosis, in which the child has shortness of breath during activity, movement, load. Inhalation is more difficult than exhalation.
Second degree. This is a croup with subcompensated disorders, in which shortness of breath appears in a child not only during exertion, but also at rest.
Third degree. In this condition, oxygen starvation develops, shortness of breath is severe, lips may begin to turn blue, and the skin may turn pale. It is noticeably difficult for the child to breathe.
Fourth degree. This is the last and most severe complication in which deep hypoxia develops, which can be fatal. All organs and systems of the child's body are affected, and first of all the brain and nervous system. Some changes, even if the child can be saved, will be irreversible.

Symptoms

False croup does not develop from the very onset of the underlying disease. Usually the first signs of laryngeal edema with stenosis begin 2-3 days after the onset of the disease. Parents can notice warning signs by the most important diagnostic symptom - the appearance of a dry barking cough, which is often called "seal bark".

The cough is very rough, tearful. As the edema develops, hoarseness of the voice may appear, but the voice does not completely disappear with false croup, as it happens with true, diphtheria. During crying, coughing, the voice will increase, and this is one of the main differences between a false croup and a true one.

Another characteristic feature is noisy breathing. It changes from the first minutes of croup development. It becomes dry, wheezing, the degree of sound effects directly depends on the degree of narrowing of the larynx, on the stage of stenosis. In the initial compensated stage, shortness of breath will be insignificant, whistling episodic. At the second stage, shortness of breath will become dry and frequent, it will interfere with the child's sleep and focus, the first vascular disorders will begin - pallor of the skin will appear.

At the third decompensated stage, hoarseness and heart rhythm disturbances appear. The child ceases to be active, he is very drowsy, lethargic, because he is experiencing severe oxygen starvation. The baby may begin hallucinations, delusions, episodes of loss of consciousness. At the last stage of false croup, the most characteristic symptoms disappear - barking cough and wheezing when inhaling. The child's blood pressure decreases, muscle cramps may appear, consciousness leaves him, immersing the baby in a hypoxic coma.

The most common attacks of false croup occur at night. They are accompanied not only by severe shortness of breath and suffocating cough, but also by panic, crying, and anxiety of the child. The kid definitely needs urgent help.

Diagnostics

Pediatric doctors usually have no problems with the correct diagnosis. Complaints about the main (often viral) disease, cough, runny nose, high fever, shortness of breath will certainly force the doctor to listen to the child's lungs more carefully. By the nature of wheezing, false croup is unlike any other disease, it is almost impossible to confuse it.

To make sure of the viral origin of the disease, as well as to identify possible bacterial infections that could join, take a swab from the throat for bacterial culture. If the doctor has reason to believe that the child has started hypoxia caused by a false croup, he will definitely carry out an analysis for the oxygen content in the blood, the so-called KOS (acid-base) analysis.

An x-ray helps to see the place of narrowing of the larynx, as well as to assess possible complications. X-rays of the lungs and the paranasal sinuses are prescribed.

Urgent care

During an attack with a false croup, it is required to be able to correctly and quickly provide emergency assistance. It consists in immediately calling an ambulance. While the doctors are traveling, parents should try to calm the baby, because the inability to take a full breath scares him, and during a fright, the muscles spasm and respiratory failure becomes even more severe.

The child must be put to bed and covered with a warm blanket, all windows and vents in the house must be opened, and if necessary, the child must be taken to the balcony so that he has constant access to fresh air. The supply of oxygen significantly facilitates the condition of the child.

A baby can be given one dose of an antihistamine, allowed by age and in strict accordance with age dosages. It could be "Suprastin", "Loratadin", "Tavegil"... These drugs help to quickly reduce tissue swelling, and breathing will become more free as the swelling decreases.

You do not need to give other drugs, with the exception of antipyretics, if the child has a high fever. In order not to complicate his already serious condition with febrile convulsions, after the thermometer shows a temperature above 39.0 degrees, you need to give "Paracetamol" or Ibuprofen, but acetylsalicylic acid ("Aspirin"), since it can lead to the development of Reye's syndrome in babies.

This is where first aid ends. All other manipulations are performed by a doctor. In severe forms of false croup, the child may need intubation. Therefore, in no case should you refuse hospitalization. Once removed, an attack of false croup may well return after a few hours, but it will recur even more difficult and swiftly.

Treatment

Mild false croup can be treated at home. Moderate pathology is treated in a hospital, severe croup requires conditions in the intensive care unit.

Easy degree. Inhalation is one of the most affordable treatments for mild croup with minor stenosis. For such procedures it is best to use special devices - inhalers. Unlike a pot of potatoes or a bowl of boiling water, steam inhalers, when used correctly, do not burn the respiratory tract.

With croup, the child should not be inhaled with herbal and essential ingredients. They are irritants and can increase the degree of stenosis.

For inhalation, it is desirable to use ordinary water vapor or saline. A nebulizer for croup is ineffective, since its principle of action is to bring fine particles of a medicinal substance to the lower respiratory tract (bronchi and lungs).

A doctor should prescribe inhalations. A child with a false croup, even if expressed in a very mild and mild stage, must be observed by a specialist, since the line between mild stenosis and critical narrowing of the airways is too thin.

As the main treatment, drugs are prescribed that are necessary for the treatment of the underlying disease. Usually these are some antiviral agents (if necessary - Tamiflu, other drugs - at the request of the parents, since most modern antiviral drugs have no proven effectiveness), vitamins, antipyretic drugs based on paracetamol. You can use a solution to rinse your sore throat. Derinat.

Average degree. It is best to treat false croup with severe shortness of breath and beginning hypoxia in a hospital, since rather serious medications will be used in therapy, many of them intramuscularly and intravenously. Usually, glucocorticosteroid hormones such as "Prednisolone" or "Dexamethasone" are used to relieve respiratory failure. In addition, the child is prescribed anti-inflammatory drugs, mainly non-steroidal ones, as well as the administration of intravenous solutions with nutrients and vitamins. Separately, it should be said about the use of vascular drugs, the introduction of which makes it possible to reduce the negative impact of oxygen starvation on the brain and nervous system of the child.

Dose "Dexamethasone" with medium-light false croup is 0.6 mg for each kilogram of the baby's weight. If the symptoms are not too pronounced, the drug is allowed by mouth. With moderate severity of croup, the drug is most often injected intramuscularly in the same dosage.

For children with such a false croup, inhalation with adrenaline is often carried out. In this procedure, a nebulizer is used to disperse the drug (Epinephrine) into very small particles that quite easily penetrate the bronchi, trachea and lungs. Most often, this helps to avoid intubation. However, such treatment causes heated debate among doctors - some experts argue that inhaling adrenaline is a placebo effect, others are sure that this is an excellent way to relieve an attack of respiratory failure. This inhalation is carried out in a hospital, since the child after it takes several hours to be under medical supervision.

Severe degree. In severe forms of false croup, staying in the intensive care unit is indicated until the moment when the threat of suffocation has passed. Then the child is transferred to the general department. Treatment consists in the introduction "Dexamethasone", inhalation with adrenaline, as well as the supply of oxygen from the outside. One in ten babies with severe false croup requires endotracheal intubation. During the manipulation, a special tube is inserted into the trachea, which provides an artificial airway.

However, not all so simple. Quite often, the tube, like a foreign body, injures the inflamed area of the respiratory system, and then the so-called subglottic stenosis develops. That is why it is recommended to remove the tube as soon as the child begins to breathe on his own, without leaving it in the trachea "just in case."

Sometimes a tracheostomy is performed to save a child's life. With it, an incision is made in the trachea, through which a special device is brought out, a kind of air intake. One end of the tube is placed in the trachea, the other is outside. This will give the baby air until the stenosis can be removed.

As a matter of urgency, every emergency doctor can perform such operations even at home. If the child is in serious condition, if the doctor has fears that the small patient will not be taken to the hospital alive, the doctor can dissect the trachea with an ordinary kitchen knife, and instead of a special tube, use a spout from a porcelain teapot.

Sometimes children with severe forms of false croup are given inhalations with Budesonide. This corticosteroid drug shows high efficiency in respiratory failure, however, its widespread use is impossible due to a huge number of side effects - it increases blood pressure, can lead to glaucoma, cataracts, cause dysfunction of the adrenal cortex, disrupt the production of sex hormones, and causes severe allergic reactions etc. Therefore, the drug is used only for vital indications, when the child's life is in danger, and the expected benefit from the use "Budesonide " exceeds the possible side risks.

Antibiotics for severe false croup are not prescribed unless concomitant bacterial ailments have been identified. Antiviral drugs are rarely prescribed if severe stenosis has developed against the background of a severe viral infection. These antiviral drugs are administered intravenously or intramuscularly in a hospital setting.

Forecasts

Viral false croup is not as often fatal as it might seem. This is because it can self-stop. Usually, the peak of the disease occurs on days 2-4, after which it takes about a week to reverse the development of stenosis.

To a large extent, the predictions depend on the stage with which the child was taken to the hospital or called a doctor at his house. The sooner parents and doctors noticed a narrowing of the airways, the earlier they took action and started treatment, the less likely it is that it will come to severe oxygen starvation and death.

Croup of moderate to severe degree rarely disappears without a trace. Usually, even with proper treatment, it leaves behind some consequences, for example, brain dysfunction, neurological disorders, complications in the form of kidney and heart diseases.

Prevention

Due to the high prevalence of viral infections in childhood, especially in autumn and winter, the risk of developing false croup is also assessed as significant. This is especially true for children who often suffer from ARVI. That is why it is important that parents take care of the observance of measures that will help avoid such a terrible and dangerous complication:

There should be a humidifier in the child's room. A relative humidity of 50-70% helps not only to protect the child from private illnesses, but also maximizes the speed of recovery of babies if they do get sick with a respiratory infection.
It is advisable to have an inhaler in the house. He will help, if necessary, carry out all the necessary procedures at home.

During ARVI illness the child should drink more, breathe sufficiently moist air. Correct treatment is important to avoid complications. Do not give medications without the permission and prescription of a doctor, especially antibiotics. You do not need to give honey, red berries and put mustard plasters so as not to aggravate the edema with allergic edema. A newborn or an eight-month-old baby, as well as all babies under one year old, must be shown to a doctor at the first signs of a respiratory infection.
Hardening, walking in the fresh air and proper nutrition help to strengthen the immune system and reduce the risk of complications.