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CROUP: Barking Like Cough

1 year female child presented with fever, cough and cold since 3 days. Parents complain of barking type of weired cough since 1 day and is not getting relieved with cough syrups.

Child was examined and assessed and showed with clear chest but a noisy sound while breathing (stridor) and yes barking type of cough could be heard.

Immediately patient was given nebulisation with Adrenaline and Budecort with humidified air and after assessment child was sent home with nebulisation with budecort and normal saline. After 24 hours of home management child came for follow up and turn out to be little better than before. The same treatment continued for 5 days and child got relieved of symptoms soon. Child was diagnosed with Croup.

So what is a croup and how to diagnose and manage such a condition?

It is a viral respiratory illness. It affects children between 6 months-3 years of age

Source
• Cross infection
• Hands

Etiological agent is parainfluenza virus (most common) and others are like adenovirus, rhinovirus etc.
• Symptoms presents after 1-3 days of fever
• Cough occurs more between 10pm to 4am
• Resolves in 3-7 days or 2 weeks

Manifestations
• fever
• Hoarsness of voice
• Barking cough
• Respiratory distress in severe cases
• Coryza may be absent or mild to moderate
Stridor occurs due to narrowing of larynx, trachea below the level of glottis.

Diagnosis
• X-ray chest- is characteristic and shows steeple or pencil sign of proximal trachea in AP view.
• Lateral X-ray neck should be done to rule of differential diagnosis
• Else no lab test should be done as it a clinical diagnosis except for saturation monitoring and ABG in severe cases

Prognosis is excellent and recovery is complete. Mostly managed at home, rarely require hospitalization.
Secondary bacterial infection leads to complications

Differential Diagnosis
• Foreign body
• Diphtheria
• Laryngomalacia
• Epiglotitis
• Measles

Treatment
Emergency treatment for severe cases

  • Hospitalization
  • Vital monitoring
  • Cold humidified air to inhale
  • Adrenaline and steroid inhalation
  • Dexamethasone injection

No role of antibiotics except if secondary bacterial infection sets in

At Cuddles Child Clinic we diagnose and treat the ailment with proper guidance to parents. We assess the need for hospitalization and manages patient accordingly.

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