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Viral Croup & Viral Bronchiolitis

14 Apr 2005 7:34 PM - Dr Roger Morris

As winter approaches, certain respiratory infections in children become more prevalent. Some of these can be more serious than the common cold, especially in babies less than six months old.

CROUP is viral infection of the voice box (larynx) and large windpipe (trachea) causing swelling and narrowing of the upper airway, usually just below the voice box. It usually affects children under the age of five. Croup often begins like a normal cold followed by a harsh, barking cough, described as ‘croupy’. This often occurs at night when the air is cooler. Croup can get worse quickly.

Croup is usually self-limiting and often no treatment is required. The most important thing is to keep the child calm and avoid distressing them too much, as this can make the airway obstruction worse. Studies have not convinced doctors that steam or vaporisers have a definitive role to play in the treatment of croup, but some parents find it helpful to put their child in a warm, steamy bathroom. If children with croup are really struggling to breath and are making a gasping noise when breathing in (called ‘inspiratory stridor’) then immediate medical assessment is necessary. These children will usually be given an anti-inflammatory medicine called prednisolone to help reduce the swelling in their upper airway. Most croup runs its course in 3-4 days and antibiotics are unnecessary, as croup is usually caused by one of a group of viruses. Some children have recurrent episodes of croup, but will usually grow out of it by early primary school.

BRONCHIOLITIS is a chest infection that is caused by one of a group of viruses, occurring mainly in babies under 6 months. These viruses can affect the small airways called bronchioles (unlike croup which affects the large upper airways). It can cause narrowing of these small airways by swelling and mucous, resulting in wheezing, cough and trouble breathing. The child may also have cold like symptoms such as fever, runny nose and irritability. The rapid, wheezy breathing may lead to feeding difficulties and predispose to choking episodes and aspiration of milk into the lungs.

Most children with bronchiolitis do not require any active treatment but should be observed closely for signs of deterioration. Antibiotics are not required, as it is caused by a viral infection. Medicines that open up the small airways like Ventolin can be useful in children older than 6 months, but many children with bronchiolitis don’t respond to this treatment. Young babies, those struggling to breathe and those struggling to feed should be admitted to hospital for observation and oxygen support.

In children with a personal or family history of allergy, eczema, hay fever and asthma, repeated episodes of wheezing need to be differentiated from early presentation of asthma which has very similar appearances.