False croup in children, what is it, symptoms and treatment, first aid

What is false croup?

False croup, (or acute stenosing laryngotracheitis) Is a symptom complex that develops with inflammatory changes in the mucous membrane of the larynx and trachea due to edema in the subfold space.

Causes and mechanisms of development

The main cause of false croup is an acute respiratory viral infection caused by the parainfluenza virus (most often), flu, respiratory syncytial virus and adenovirus.

Less commonly, false croup can be caused by bacteria - mainly streptococcus and staphylococcus.
Often a false croup is allergic reaction organism on the impact of one or another allergen, as well as a consequence of local trauma.

In adults, false croup practically does not occur - they only have true croup, which develops with such an infectious disease as diphtheria.

False croup is a common complication 

ARVI in children under 6 years of age. This is due to the anatomical and physiological features of the upper respiratory tract of babies, namely:

• small size and narrow lumen of the larynx;
• a large amount of loose connective and lymphoid tissues in the subglottic space (the younger the child, the more this tissue is, and it is highly susceptible to edema);
• elongated, loose epiglottis;
• the softness of the cartilaginous skeleton;
• high development of the circulatory and lymphatic systems in the upper respiratory tract.

The above features contribute to the occurrence of stenosis components against the background of inflammation - spasm and edema.

So... Due to inflammatory changes in the mucous membrane of the larynx, manifested by edema and the production of viscous discharge, the lumen of the larynx narrows, its mucosa dries out, crusts form on it, which makes the lumen of the larynx narrower more. When the child is anxious, there is also a reflex spasm of the smooth muscles of the larynx.

Symptoms and Signs

False croup symptoms:

• hoarseness of voice;
• dry barking cough;
• labored breathing.

Acute stenosing laryngotracheitis is characterized by the presence of three symptoms simultaneously:

• harsh, rough barking cough:
• hoarseness, hoarseness - dysphonia;
• the so-called inspiratory stridor - difficult wheezing, wheezing, bubbling breathing.

In addition to the above symptoms, the patient may have other signs of an underlying disorder, including:

• fever (increased body temperature);
• rhinitis (runny nose);
• discharge from the conjunctiva (usually with an adenovirus infection), lacrimation.

It should also be noted that the described condition usually develops in the evening or at night during sleep, when the child is in a horizontal position.

In practical medicine, it is customary to distinguish 4 stages of acute stenosing laryngotracheitis:

1. Compensated stenosis. The child's condition is assessed as moderate. His consciousness is clear. At rest, breathing is free, even, with motor or emotional arousal shortness of breath appears - when breathing, there is noticeable retraction of the jugular fossa (located above the sternum) and intercostal intervals. Heart rate is 5-10 percent higher than normal values ​​for a given age. Periodically, there is a rough barking cough.
2. Subcompensated stenosis. The patient's condition is grave. The child is agitated, his skin is pale, around his mouth - with a cyanotic tinge. At rest it is noted dyspnea - a loud breath with retraction of the intercostal spaces, jugular and supraclavicular fossae. Bubbling breathing is interrupted by bouts of rough, deep barking cough. The voice is considerably husky. The heart rate is 10-15 percent higher than normal.
3. Decompensated stenosis. The child's condition is extremely serious. There is a clouding of consciousness, a pronounced lethargy or, conversely, arousal. There is inspiratory dyspnea with extremely difficult inhalation, which is accompanied by a sharp retraction supraclavicular and jugular fossa, intercostal spaces, epigastric region (the area under the sternum - between ribs and navel). Exhalation is reduced, the skin is pale, spreads cyanosis. The heart beats more than 15 percent faster than normal. Blood pressure drops.
4. Asphyxia - the child's condition is extremely serious. Consciousness is absent. Skin with a bluish tinge (cyanotic). The pupils are dilated. Breathing is shallow, rare or absent altogether. Heart sounds are muffled, their frequency is very difficult to calculate. The pressure is drastically reduced. Convulsions are possible.

Diagnostics

Diagnostics is not difficult. The diagnosis is made by an ambulance doctor, pediatrician or otorhinolaryngologist based on anamnesis data (the condition developed against the background of ARVI), a typical clinical picture of false croup (the triad of symptoms described above), the results of an objective examination of the patient (visual examination, assessment of the nature of breathing, cardiac activity, monitoring of arterial pressure). In a hospital, laryngoscopy is performed (for the purpose of visual assessment of the state of the mucous membrane), taking a smear from throat followed by microscopic examination and inoculation on a nutrient medium (for verification pathogen). In order to assess the degree of oxygen starvation of the body, a study of the gas composition of the blood and the acid-base state is carried out.

According to indications, in order to diagnose the underlying disorder or possible complications, the following can be performed:

• otoscopy;
• X-ray of the paranasal sinuses and lungs.

Differential diagnosis

False croup must be differentiated from true diphtheria croup, acute epiglottitis, retropharyngeal abscess, foreign body in the larynx and acute obstructive bronchitis.

• True diphtheria croup accompanied by a low (subfebrile) temperature, hoarse voice (the patient seems to "speak in the nose"). Runny nose and other catarrhal phenomena are absent. Signs of stenosis develop gradually. When examining the oral cavity, attention is drawn to the tonsils: they are enlarged, with dirty gray films that are difficult to remove with a spatula. From the patient's mouth - the smell of rot.
• Acute epiglottitis Is an inflammation of the epiglottis region. Signs of stenosis of the larynx increase gradually, characterized by severe inspiratory dyspnea, dysphagia and general anxiety of the patient. His condition is grave, the position of the body is forced (sitting), the temperature rises to febrile figures. Examining the oral cavity, you can see the root of the tongue is dark cherry color. During laryngoscopy - edema of the epiglottis and epiglottis.
• Retropharyngeal abscess always debuts acutely with an increase in body temperature to febrile digits, increasing shortness of breath with difficulty breathing, turning into suffocation, with pronounced general anxiety. The patient's position is forced - with the head thrown back and to the affected side. Snoring breathing, difficult especially when the patient is lying down. Salivation is increased. When examining the pharynx, bulging of the posterior wall and a symptom of fluctuation are noticeable, indicating the presence of an inflammatory fluid in the study area.
• In favor the presence of a foreign body in the larynx, partially covering the lumen of the organ, indicates a sudden onset of the disease, anxiety of the patient, the complete absence of signs of inflammation and intoxication. In the case of complete obstruction, the patient cannot breathe in, speak. Pointing fingers to the neck. There is an inspiratory stridor, paroxysmal cough.
• Obstructive bronchitis characterized by signs of inflammation in the upper respiratory tract. Those. the patient complains of a runny nose, cough, hoarseness of the voice may be present. The body temperature rises to 37–38 ° C, there are signs of moderate intoxication. Attention is drawn to pronounced expiratory dyspnea, i.e. it is difficult for the patient to exhale. With percussion of the lungs - a boxed tone of sound, with auscultation - dry and wet medium and large bubbling rales over the entire surface of the organ.

Emergency care for false croup and its further treatment

To cause reflex vasodilation and thereby alleviate the condition of a child with an attack of false croup, it is necessary prepare a foot bath for him - offer to put his feet in a bath of warm water, and also provide a fresh, wet room in the room warm air.

False croup is a condition requiring urgent medical attention, since if the necessary measures are not taken, it will progress and can even lead to death. Therefore, if, against the background of an acute respiratory viral infection, you notice an increase in shortness of breath in a child and other signs described above, you are required to:

• call an ambulance;
• give the patient an elevated position in bed or take the child in his arms;
• calm him down (since anxiety, emotional arousal aggravates laryngospasm);
• provide an inflow of fresh moist air;
• give a warm drink;
• to cause reflex vasodilation, you need to turn on hot water in the bathroom (so that steam), bring the child here and make him a warm foot bath or lower the hands in a warm (37-40 ° C) water;
• turn on a humidifier, if there is one.

If the ambulance has not arrived yet, and the child's condition worsens, you can give the child some medications:

• antihistamine (Cetirizine, Loratadin, etc. - depending on age);
• antispasmodic (papaverine, No-Shpa);
• a preparation containing salbutamol (syrups Bronchoril, Instaril or inhalation of salbutamol directly - Ventolin).

Further treatment should be carried out in a hospital and be prescribed by a specialist.

In the first stage of false croup, treatment includes inhalation dosed corticosteroids (Flixotide) in an age-related dosage 2 times a day immediately until the patient's condition improves; inhalation of salbutamol (Ventolin); infusion of aminophylline solution; antispasmodic injections; sedatives (valerian, bromide); antihistamines and other symptomatic therapy.

At 2-4 degrees of stenosis of the larynx, the patient is given intravenous stream or intramuscularly prednisone.

Prevention

Prevention of this condition consists in preventing the development of acute respiratory infections, and in case of illness with them - adequate and timely therapy. The main thing in this situation is the correct microclimate in the room where the patient is. Namely, humid (60–65%) cool (18–20 ° С) air, regular ventilation of the room (every hour for 15 minutes), drinking plenty of fluids.

Children prone to allergic diseases should avoid contact with potential allergens.

If a false croup has developed once, parents should keep in mind that it can recur, and, after consulting your doctor, stock up on medications that may be useful in case of disorders .