A disease of the respiratory tract, resulting in stenosis of the larynx, is called croup in medical science. This ailment is accompanied by the following symptoms: noisy shortness of breath, hoarseness, "barking" cough, shortness of breath. Croup in a child is not a rare phenomenon. As a rule, it occurs against a background of various infectious diseases. In this article, we will consider in detail the main issues relating to such a problem as croup in children.
Causes
Very often, the aforementioned ailment develops with various infectious diseases, such as measles, flu, chickenpox, tuberculosis, typhoid fever, and syphilis. Even a commonplace ARI can provoke this pathology. Croup often occurs as a complication of diphtheria. In some cases, ordinary herpes can cause the disease. At the same time, along with swelling of the laryngeal mucosa and hyperemia, a rash may occur. First, they will be dotted papules, and then erosion, covered with a yellow-white thin film. Do not neglect factors such as adverse ecology, weather dependence, and weather conditions. Most often, the disease is diagnosed in children living in industrial (contaminated) areas, as well as near polluted highways. A major role in the occurrence of pathology is played by a change in the reactivity of the child's body. The reason for this is various para- and hypotrophy, encephalopathy, rickets, thymo-lymphatic status, exudative diathesis, pneumonia and neurological pathologies. Some children with croup have a history of drug or food allergies, sensitization, and bronchial asthma.
Who is at risk?
The most commonly diagnosed viral croup in children under three years of age. This is due to the anatomical and physiological structure of the respiratory system of babies. In children of the mentioned age group, the lumen of the larynx is much narrower, and the cartilage tissue is more supple and tender than in an adult. The vocal cords are short. The submucosal layer consists of rather loose connective tissue. That is why with inflammation of certain sections of the respiratory tract, edema often occurs, leading to a narrowing of the lumen of the larynx.
Pathogenesis
Larynx in the body of the child performs voice-forming, respiratory and protective functions. Any narrowing of it can cause impaired patency of the upper respiratory tract, as well as oxygen starvation of vital organs (heart, brain, kidneys, etc.). Croup in a child is the result of inflammation. Ulcers, swelling, necrosis, superficial erosion, damaging the mucosa, cause a reflex spasm of the muscles of the larynx. With stenosis, oxygen deficiency quite often develops, and the air ventilation of the upper respiratory tract is disrupted. Then there is metabolic and respiratory acidosis, hypoxemia, cerebral edema. This kind of disorder complicates the course of stenosis.
Croup in children: symptoms
The first signs of an ailment occur at night. Their appearance is due to anatomical and physiological factors: at this time a high tone of the parasympathetic nervous system is noted, in a horizontal position, as a rule, drainage of the lungs worsens. Typically, a child’s croup begins with an increase in temperature (up to 39 degrees).
A runny nose also appears. Within twelve to forty-eight hours, a “barking" rough cough appears, reminiscent of a croaking. Often it is accompanied by increased breathing, retraction of the intercostal spaces, stridor. At the same time, while crying, the cough only intensifies. On examination, the doctor notes a narrowing of the larynx and trachea. This causes the appearance of the so-called noisy breathing, in which it is difficult for the baby to take a breath, as well as hoarseness and hoarseness. When exposed to cold and humid air, the symptoms are alleviated.
Signs of diphtheria croup
The main symptom is a gradual increase in stenosis, leading to a steady progression of the severity of the condition. Characteristic features are also “toxic” pallor of the skin, hoarse, and then soundless cough. From the nose, due to paresis of the soft palate, fluid may leak. Croup in children, whose symptoms are very unpleasant, is characterized by the formation of gray-dirty plaque on the tonsils. At the same time, a putrefactive smell emanates from the mouth. It should be noted that at night a rapid deterioration of the condition is possible, leading to an extremely serious, even fatal, outcome. Therefore, upon detection of alarming symptoms, an ambulance should be called immediately.
Diagnostics
To identify an ailment, the main cause of which is a viral disease, in children can be endoscopic methods. When examining the larynx, the mucous membrane looks swollen, hyperemic, easily wounded. In this case, edematous ridges are noticeable in the sub-folding space. The contours of the rings of the bronchi and trachea are smoothed. Mucopurulent exudate in some cases is sparse and thin, but most often it is thick and viscous. Often, fibro-necrotic overlays are formed. After removal of plaque and casts, the lumen of the trachea becomes wide. However, its walls are a continuous bleeding wound. Inflammatory swelling of the mucosa leads to the fact that the mouths of the bronchi become slit-like, and sputum (purulent) appears from the depths.
Analyzes
Today, the method of serological diagnosis of croup has gained great importance. It is based on the use of sets of antibodies to specific viruses and bacteria. The PCR (polymerase chain reaction) method is also widely used. However, this method will be effective only if the biomaterial is taken early from the oropharynx (in the acute period). Using a blood test, you can identify non-specific inflammatory changes. So, with bacterial croup, leukocytosis is observed, with viral - leukopenia. For a more accurate diagnosis, as well as for suspected complications, X-ray methods are used (images of the cervical spine, paranasal sinuses, chest, etc.). Another method is differential diagnosis. Here the main role is played by the clinical picture of the disease. The presence of previous diseases that can cause this complication is also taken into account.
Therapy Features
It is recommended to show the child to the doctor as soon as possible. Treatment of croup in children should first of all be aimed at relieving airway edema. Today, hormonal drugs are used for these purposes. In this case, it is recommended to feed or drink the baby as often as possible to avoid dehydration. You can bring down the temperature and relieve pain with ibuprofen or paracetamol. In this case, you must carefully read the instructions for dosage or consult a doctor about this. You can also use antispasmodics, such as Baralgin, Maxigan, Snazgan, etc. At the same time, crumbs up to a year are recommended to give 1/3 tablets, and older children 1/2. Decongestants and antitussive drugs will not help cure a child’s croup, but they will significantly ease the condition of the baby. These are the first steps you can take before a doctor arrives. You should also ensure that cool fresh air enters the room.
Inpatient treatment
At the resuscitation stage, the main attention is paid to the restoration of airway patency and the fight against toxicosis caused by an infectious disease. For these purposes, the method of nasotracheal intubation is used. Indications for its use are cardiovascular and respiratory failure caused by stenosis of the larynx 2, 3 and 4 degrees, as well as increasing hypoxia and hypercapnia.
Intubation is performed under general anesthesia. However, this method has its drawbacks. First of all, these are post-intubation chondroperichondritis of the trachea and larynx leading to cicatricial stenosis. To prevent such complications, it is recommended to use special thermoplastic tubes. In addition, the treatment of croup in children is unthinkable without adequate antibacterial therapy, which is prescribed by the doctor, based on the individual characteristics of the baby. With this disease, as a rule, hormonal drugs are prescribed that contribute to the rapid relief of stenosis caused by sudden swelling of the laryngeal mucosa. In some cases, glucocorticoid drugs are administered to patients. If in the first two hours after taking hormones their effectiveness is not detected, further use of these drugs is impractical. In the fight against toxicosis,
infusion therapy is used.Treatment of recurrent croup
With this disease, bronchodilators, mucolytics, etiotropic and anti-inflammatory drugs are used. Dosed inhalers are effective. Particular attention should be paid to the elimination of edema that causes spasms. Mucolytic drugs will help restore normal functioning of the respiratory system. Secretolytics (Ambroxol and Bromhexine) help to thin the sputum, stimulate the formation of surfactant in the lungs. As
anti-inflammatory drugs, as a rule, cromoglicate preparations are used. After stopping the acute manifestations of croup, in order to prevent hypersensitivity of the bronchi and larynx, it is necessary to conduct a long-term (about two months) therapy with H1 receptor blockers (the drug "Cetirizine"). During the period of convalescence, immunostimulating drugs are prescribed. Their choice depends on the age of the child, the presence of an etiotropic pathogen, the prevalence of the inflammatory process. Such drugs include Bronchomunal and interferon preparations. Moreover, the duration of treatment after discharge from the hospital should be at least one month.
Croup Prevention
The main attention should be paid to hardening the child. You should often walk with the baby in the fresh air. This will help improve the functioning of the upper respiratory tract and strengthen immunity. You can also do hardening of the throat. To do this, rinse it with cool water every day, gradually reducing the temperature of the liquid. However, in this case do not rush. The addiction process should take at least two months. In the final embodiment, the water temperature is about 14-15 degrees. For older children, ice resorption can be used as hardening. It is best to freeze water in a small-cell mold by mixing it first with lemon juice. On the day, the child can be given one dice.
Prevention of viral diseases in children is to adhere to the principles of proper nutrition and the use of vitamins. This will help strengthen the body's defenses and will contribute to the proper and healthy development of the baby. It is very useful to eat fresh vegetables and fruits, drink herbal teas and decoctions. They not only strengthen the immune system, but also help in the fight against emerging early infections and viruses. It is recommended to give the child foods rich in vitamins C and A. Fermented milk products, especially lively kefir, are very useful for health.
It is important that the air in the apartment is warm and fresh. In this case, a certain humidity should be maintained. Do not forget about the rules of hygiene. And smoking near a child is strictly prohibited. It is also not recommended to use aromatic oils, candles, etc. in the room where the baby is located. They can cause serious respiratory irritation.