False croup treatment at home. False croup in children

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 subglottic space.

Causes and mechanisms of development of false croup

Main reason this state is an acute respiratory viral infection, caused (most often) by influenza, respiratory syncytial virus and adenovirus.

Less commonly, acute stenosing laryngotracheitis can be caused by bacteria - mainly streptococcus and staphylococcus.
Often, false croup is the body’s reaction to exposure to a particular allergen, as well as a consequence of local trauma.

In adults, false croup practically does not occur - in them only true croup is possible, which develops with an infectious disease such as diphtheria.

False croup is a common complication in children under 6 years of age. This is due to the anatomical and physiological characteristics of the upper respiratory tract of babies, namely:

• small size and narrow lumen of the larynx;
• a large amount of loose connective and lymphoid tissue in the subglottic space (than younger child, the more this tissue is, and it is highly susceptible to swelling);
• elongated, loose epiglottis;
• softness of the cartilaginous skeleton;
• highly developed circulatory and lymphatic systems in the area of ​​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 mucous membrane dries out, crusts form on it, causing the lumen of the larynx to narrow even more. When a child is restless, a reflex spasm also occurs. smooth muscle larynx.

Manifestations of the disease

Symptoms of false croup: hoarseness, dry barking cough, difficulty breathing.

Acute stenosing laryngotracheitis is characterized by the presence of 3 symptoms simultaneously:

• annoying, rough barking cough:
• hoarseness, hoarseness of voice – dysphonia;
• so-called inspiratory stridor - difficult whistling, wheezing, bubbling breathing.

In addition to the above symptoms, the patient may have other signs of the underlying disease: fever, runny nose, discharge from the conjunctiva (usually with 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 laryngeal stenosis:

I – compensated stenosis. The child's condition is assessed as medium degree gravity. His consciousness is clear. At rest, breathing is free and even; with motor or emotional excitement, shortness of breath appears - when breathing, retraction of the jugular fossa (located above the sternum) and intercostal spaces is noticeable. Heart rate is 5–10% higher normal values for a given age. A rough barking cough occurs periodically.

II – subcompensated stenosis. The patient's condition is serious. The child is excited, his skin is pale, around the mouth there is a cyanotic tint. At rest, shortness of breath is noted - a loud inhalation with retraction of the intercostal spaces, jugular and supraclavicular fossae. The bubbling breathing is interrupted by bouts of rough, deep, barking cough. The voice is significantly hoarse. Heart rate is 10–15% higher than normal.

III – decompensated stenosis. The child's condition is extremely serious. There is confusion, pronounced lethargy, or, conversely, agitation. There is inspiratory shortness of breath with extremely difficult inhalation, which is accompanied by a sharp retraction of the supraclavicular and jugular fossae, intercostal spaces, epigastric region(the area under the sternum - between the ribs and the navel). Exhalation is reduced, the skin is pale, cyanosis spreads. The heart beats more than 15% faster than normal. Blood pressure drops.

IV – asphyxia – the child’s condition is extremely serious. There is no consciousness. Skin with a bluish tint (cyanotic). The pupils are dilated. Breathing is shallow, rare or absent altogether. Heart sounds are muffled and their frequency is very difficult to calculate. The pressure is sharply reduced. Convulsions are possible.

Diagnosis and differential diagnosis

Diagnosis is not difficult. The diagnosis is made by an emergency physician, pediatrician or otorhinolaryngologist based on medical history (the condition developed against the background of acute respiratory viral infection), the typical clinical picture of the disease (the triad of symptoms described above), the results objective examination sick ( visual inspection, assessment of the nature of breathing, cardiac activity, monitoring of indicators blood pressure). In a hospital setting, laryngoscopy is performed (for the purpose of visually assessing the condition of the mucous membrane), taking a smear from the pharynx, followed by microscopic examination and sowing on nutrient medium(to verify the 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 disease or possible complications, the following can be carried out:

• otoscopy;

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 is accompanied by a low (low-grade) temperature and a hoarse voice (the patient seems to be “talking through his nose”). There are no runny nose or other catarrhal symptoms. Signs of stenosis develop gradually. Upon examination oral cavity The tonsils attract attention: they are enlarged, with dirty gray films that are difficult to remove with a spatula. The patient's mouth smells of rot.

Acute epiglottitis is an inflammation of the epiglottis area. Signs of laryngeal stenosis increase gradually and are characterized by severe inspiratory shortness of breath, dysphagia and general anxiety of the patient. His condition is serious, his body position is forced (sitting), his temperature rises to febrile levels. Examining the oral cavity, you can see the root of the tongue is dark cherry in color. During laryngoscopy - swelling of the epiglottis and epiglottis.

A retropharyngeal abscess always debuts acutely with an increase in body temperature to febrile levels, increasing shortness of breath with difficulty in inhaling, turning into suffocation, and severe general anxiety. The patient's position is forced - with the head tilted back and to the affected side. Breathing is snoring, difficult especially when the patient is lying down. Salivation increased. When examining the pharynx, there is a noticeable bulging of the posterior wall and a symptom of fluctuation, indicating the presence of inflammatory fluid in the area of ​​examination.

The presence of a foreign body in the larynx, partially closing the lumen of the organ, is evidenced by the sudden onset of the disease, the patient’s anxiety, and the complete absence of signs of inflammation and intoxication. In case of complete obstruction, the patient cannot take a breath or speak. Points fingers at neck. Inspiratory stridor and paroxysmal cough are noted.

If false croup has developed once, parents should keep in mind that it may recur, and, after consulting with a doctor, stock up on medications that may be useful if the disease occurs.

About the treatment of false croup in the program “School of Doctor Komarovsky”:

Acute laryngitis is much more dangerous for children than for adults. This is explained by the fact that the size of the larynx in babies is much smaller, so the risk of extreme narrowing of the glottis increases, and this can lead to complete cessation of breathing. Treatment of the disease is complicated by the fact that it is necessary to ensure a full larynx for at least a week, and it is extremely difficult to prohibit a child from talking for such a long period of time.

Causes of acute laryngitis in children

Another well-known name for acute laryngitis in children is false croup; in this disease, the mucous membrane lining the larynx becomes inflamed. In spring and winter periods the incidence of the disease increases slightly. Results statistical research they say that children aged 3 months to 7 years are most susceptible to this disease, and boys suffer from laryngitis more often than girls.

The main cause of false croup in children is exposure to respiratory viruses (adenoviruses, parainfluenza viruses) on the upper respiratory tract. However, bacteria can also be the causative agent of this disease. Quite often, laryngitis is a complication of infectious diseases such as scarlet fever and measles. Among the factors contributing to the occurrence of false croup in children are: poor living conditions, malnutrition of the child, deficiency of vitamins in the child’s body, hypothermia, weakness of the body resulting from physical and mental fatigue. Children who have nasal breathing severely difficult or completely absent due to the proliferation of adenoids, more often than others they develop acute laryngitis.

Possible different localization focus of inflammation. So, inflammatory process may occur on the mucous membrane covering the epiglottis, on the mucous membrane covering vocal folds, on the mucous membrane lining the subglottic space; in some cases, the inflammation process covers the entire surface of the larynx. The mucous membrane swells; irritation leads to advanced education mucus. If the source of inflammation is localized in the subglottic space, then, in addition to swelling of the mucous membrane and increased secretion of mucus, spasm of the laryngeal muscles occurs. Spasm leads to acute stenosis of the larynx, also called false croup (true croup develops). Then the child’s condition becomes serious.

Signs of an attack of false croup in children

In most cases, laryngitis does not severe course. But if the disease is severe, if due to swelling of the mucous membrane that lines the larynx, difficulty breathing occurs, the life of the sick child is in danger. With this in mind, if you suspect symptoms of acute laryngitis in children, the mother should not hesitate. She must in urgently contact your pediatrician or call " ambulance" In children 2-3 years old, signs of false croup appear quite quickly - within a day, and sometimes just overnight. This happens because the body’s resistance in children of this age is weak, and the body quickly “loses ground.”

The first symptom of false croup in children- slight malaise. Then there is an increase in body temperature - usually more than 38 ᵒC. The child's voice becomes hoarse or hoarse, more in rare cases(severe) aphonia develops, i.e. the voice disappears completely. One more thing characteristic manifestation acute laryngitis - dry barking cough in the first days of illness. Subsequently, the cough becomes wet, with the discharge of scanty sputum. The child feels rawness and burning in the throat and complains about it. If the disease becomes severe and due to swelling of the mucous membrane, breathing becomes difficult, the child becomes restless and cries; he is very scared because he has difficulty breathing. With further deterioration of the condition, an attack of false croup in children can lead to suffocation, an obvious sign of which is cyanotic (blue) lips in the baby. A doctor examining a child's larynx (JIOP doctor) sees bright hyperemia and swelling of the mucous membrane that covers the vocal cords. Edema and soft fabrics located under the glottis. Acute laryngitis usually lasts several days.

If, for the symptoms of acute laryngitis in children, treatment is not started in a timely manner, if the sick child is in unfavorable conditions, disrupts the voice mode, does not have sufficient care and therapy is not carried out to the required extent, the disease may develop into a protracted form.

What to do in case of false croup in a child: inhalations and prevention of acute laryngitis in children

What to do in case of false croup in a child, having barely suspected the first signs of the disease? Parents should under no circumstances take risks and self-medicate. As soon as the child begins to develop the clinical picture of acute laryngitis, it is necessary, without delay, to call pediatrician. When treating acute laryngitis in children, the sick child needs voice rest and strict bed rest. The child needs quality care from loved ones. Constant monitoring of the child must be ensured, since his condition, if it gets worse, gets worse quickly. Monitoring by the mother at night is especially important when treating false croup in children. The child should know that one should breathe only through the nose, because the main function of the nose is to prepare the inhaled air to pass through the respiratory tract - the air is cleaned, warmed, and moistened. If a child breathes through his mouth, he “loads” the larynx too much, and it naturally responds with inflammation of the mucous membrane. If your child has a stuffy nose, the doctor will recommend vasoconstrictor drops. Mitigates the course of the disease when abundant and frequent alkaline drink. Having identified the symptoms of false croup in children, physiotherapy is prescribed to treat the disease: UHF, diathermy on the larynx, etc. If the body temperature rises, the child is given antipyretics.

How to treat acute laryngitis in a child at home? Regular inhalations - alkaline and oil inhalations - help to cope with the manifestations of the disease more quickly. The inhalation procedure can be performed at home - using a special inhaler (many modifications of inhalers can be found on sale) or simple items such as a kettle, saucepan, rubber heating pad of suitable capacity. It is possible for a mother to give her child inhalations with a solution of furatsilin, with a solution of baking soda, with infusions and decoctions medicinal plants, characterized by antiseptic and anti-inflammatory effects. Inhalations for false croup in a child with a decoction of chamomile flowers, a decoction of the herb sage, an infusion of the herb St. John's wort, an infusion of calendula flowers are effective. With the remedies we have named, you can also gargle your child’s throat. Frequent rinsing is recommended. The effectiveness of rinses increases if the products used are alternated.

To prevent false croup in children, the following are considered: regular ventilation of living quarters, systematic walks of the child, exclusion of the child’s contact with people sick with influenza or other acute illnesses. respiratory infections, good nutrition for the child, containing sufficient vitamins. To prevent false croup in children, it is necessary to begin hardening the baby as early as possible.

Emergency first aid for false croup (acute laryngitis) in children

If difficulty breathing occurs and there is an increasing threat of suffocation, the child is taken to the hospital by ambulance.

When there is a threat of suffocation, every minute becomes valuable. And a mother whose child shows a tendency to laryngitis should know what to do in this case.

When providing emergency care for acute laryngitis in children, while someone at home calls an ambulance, you need to:

• organize quick and high-quality ventilation of the room in which the sick child is located. How more content There will be oxygen in the air, the less the baby will suffer from difficulty breathing. In the warm season, when providing assistance with false croup in children, you can open the window wide;
• in the room in which the sick child is located, you need to humidify the air - for example, hang several wet towels (preferably terry). Due to the rapid evaporation of water from the surface of the towels, the air in the room is moistened and ceases to irritate (dry out) the inflamed mucous membrane of the larynx. A boiling kettle will humidify the air in the room even faster. If it is not possible to install a boiling kettle in the children's room, you can place 2-3 pots of water that have just boiled in the corners of the room.
• When providing emergency care for false croup in children, you need to make the baby sit in a sitting position, so it is easier for the child to breathe. An older child may sit in bed or on a chair, small child It’s better to take it on your lap - this is important because a baby whose breathing is difficult is scared. It will be much easier for him to cope with fear on his mother’s lap.
• When providing first aid for false croup in children, you need to do everything to calm the child, distract him from frightening thoughts about difficulty breathing and a possible worsening of the condition. Getting excited from fear, the child begins to breathe more often, and this only aggravates the severity of the condition. Calm, slow breathing of the baby through the nose - this is what a mother should be able to achieve.

Treatment of false croup (acute laryngitis) at home with folk remedies

There are several phytomedicine recommendations on how to treat false croup in children, the most effective of them are listed below:

• if, due to a spasm of the muscles of the larynx, it becomes difficult for the child to breathe, you should try to induce vomiting - press the child with a spatula, or a spoon, or simply with your finger on the root of the tongue; it works reflex mechanism, as a result of which breathing may become easier;
• irrigate the throat with an infusion of peppermint herb; preparing the infusion: pour 1 tablespoon of dried, carefully crushed herb with a glass of boiling water and leave in a sealed container at room temperature for about half an hour, strain through a fine strainer or 2-3 layers of gauze; irrigate the child’s throat with this infusion several times a day after meals;
• irrigate the throat and oral cavity with a warm infusion of warty birch leaves; preparing an infusion; dried leaves (it is recommended to select only young sticky leaves), chop well, pour 1 tablespoon of the raw material with a glass of boiling water and leave in a sealed container at room temperature for at least half an hour, strain through 2-3 layers of gauze, squeeze out the rest of the raw material through the same gauze; irrigate the child's throat several times a day.
• When treating false croup at home, you need to irrigate the throat with a warm decoction of the herb Salvia officinalis. Preparation of the decoction; dried raw materials should be thoroughly crushed with a pestle in a mortar, 1 tablespoon of powder should be poured into a glass of boiling water and heated in a boiling water bath for about 10 minutes, after which the product should be quickly cooled, strained through 2 layers of gauze, and the remainder squeezed out through the same gauze; irrigate the throat several times a day; for catarrhal symptoms of the nose and nasopharynx, it is recommended to instill the decoction into the child’s nose while lying on his back;
• gargle with a warm infusion of the following collection: sage leaves - 3 parts, common oak bark - 3 parts, cinquefoil rhizomes - 3 parts, fennel fruits - 1 part; preparing the infusion: place 1 teaspoon of the dry, crushed mixture in a preheated thermos, pour a glass of boiling water and leave for 3-4 hours, cool, strain; gargle 5-6 times a day; alternate with other means;
• drink infusion from next collection: mix coltsfoot leaves, large plantain leaves and licorice root in equal quantities; preparing the infusion: pour 1 teaspoon of the dry, crushed mixture with a glass of boiling water and leave, covered, for at least 20 minutes, strain; drink warm, a quarter glass 3 times a day.

How and with what to treat acute laryngitis (false croup) in children at home

Here are some more tips on how to treat acute laryngitis at home using traditional medicine recipes:

• instill into the nose (the child lies on his back) 1-2 full pipettes of any vegetable oil- sunflower, corn, olive, apricot, peach, citral, etc.; after instillation, the child should lie on his back for a couple of minutes; when it rises, the oil will flow down the back wall nasopharynx, oropharynx, will reach the hypopharynx and lubricate the inflamed mucous membrane; thin layer vegetable oil will protect the inflamed mucous membrane from irritating external factors(dry air, cold air) and thereby will contribute speedy recovery; do such instillations 2-3 times a day.
• In the treatment of acute laryngitis folk remedies, you need to include more warm porridges in the menu of a sick child ( semolina porridge, oatmeal, buckwheat, rice and other porridges); when a child slowly eats warm porridge, his throat warms up, and inflammation goes away faster (heat is the enemy of any inflammation); It is recommended to add fresh ingredients to porridge butter; It is known that butter contains a lot of vitamin A; this vitamin has pronounced antioxidant properties - in other words, it is able to directly destroy the infection; in addition, butter nourishes the mucous membrane well;
• Do inhalations with clove oil 1-2 times a day;
• give the baby warm-moist inhalations using a baking soda solution; preparing the solution: dissolve half a teaspoon of baking soda in 200 ml of boiling water; performing the procedure: the child (together with the mother) bend over a cup with a solution, cover with a large towel or blanket and inhale the steam rising above the cup; duration of the procedure - 10-12 minutes;
• give the child warm-moist inhalations using an infusion of the trifid herb; preparing the infusion: pour 1 tablespoon of dried, well-chopped herb with 2 cups of boiling water and leave in a sealed container at room temperature for 45 minutes, strain through 1-2 layers of gauze and bring the product to a boil; inhale steam; This procedure is recommended to be performed within 12-15 minutes; You need to do such inhalations several times a day;
• do inhalations with an infusion prepared on the basis of the following mixture of medicinal plant materials: tripartite herb - 1 part, chamomile flowers - 1 part, white claret herb - 1 part; preparing the infusion: pour 1 tablespoon of the dried mixture, crushed into a fine powder, with a glass of boiling water and leave in a sealed container at room temperature for about 15 minutes, strain through several layers of gauze and bring the product to a boil; (for a description of the procedure, see page 30 in italics); inhale warm steam for about 15 minutes;
• do warm-moist inhalations with an infusion of black currant leaves; preparing the infusion: pour 1 tablespoon of dried, well-ground raw material into 2 cups of boiling water and leave in a sealed container at room temperature for 45 minutes, strain through 1-2 layers of gauze and bring the product to a boil; inhale steam for 10-12 minutes; do such inhalations several times a day.
• As a treatment for acute laryngitis in children, folk remedies can be drunk several times a day. warm milk with melted butter.
• For a debilitating cough, drink warm milk diluted by half with some alkaline mineral water(Borjomi is best suited for this purpose); You can also add honey - 1 teaspoon per glass of milk with mineral water;
• several times during the day, drink 1 tablespoon of lingonberry juice with honey or sugar;
• drink freshly squeezed daily carrot juice; The amount of juice that a child can take according to his age should be recommended to the mother by the local pediatrician;
• drink an infusion of wild rosemary herb; preparing the infusion: pour half a teaspoon of dry herb into a glass of cold boiled water and leave covered for 6-8 hours, strain; take a quarter glass 3-4 times a day.

An acute inflammatory process of the larynx, accompanied by swelling of its subglottic region, which leads to stenosis of the larynx and obstruction of the upper respiratory tract. False croup is manifested by a dry “barking” cough, hoarse voice and inspiratory shortness of breath, causing noisy breathing. The severity of the condition of patients with false croup depends on the degree of laryngeal stenosis and often changes during the day. False croup is diagnosed thanks to the characteristic clinical picture and auscultatory picture in the lungs, as well as data from an CBS blood test, blood gas analysis, laryngoscopy, radiography, bacterial culture, PCR and ELISA diagnostics. Treatment of patients with false croup is carried out with antibiotics, antitussives, sedatives, antihistamines and glucocorticoids.

III degree of stenosis. There is severe inspiratory shortness of breath with retraction of the jugular fossa, intercostal spaces and epigastric region during breathing. A patient with false croup has a pronounced “barking” cough, dysphonia and paradoxical breathing appear. Mixed shortness of breath is possible, which is an unfavorable sign in terms of the prognosis of the disease. Cyanosis is diffuse. The pulse is threadlike with prolapses on inspiration, tachycardia. The child’s anxiety gives way to lethargy, drowsiness, and confusion occurs. In the lungs, during inhalation and exhalation, dry and moist rales of various sizes are heard, and muffled heart tones are noted.

IV degree of stenosis characterized by the absence of a “barking” cough typical of false croup and noisy breathing. Arrhythmic shallow breathing, arterial hypotension, and bradycardia are observed. Convulsions are possible. The consciousness of a patient with false croup is confused and turns into hypoxic coma. False croup with IV degree of stenosis may end fatal as a result of the development of asphyxia.

A distinctive feature is that false croup occurs with changes in the severity of obstructive syndrome and inspiratory dyspnea throughout the day from pronounced to almost imperceptible. However greatest severity the condition is always observed at night. It is at night that attacks of false croup occur, caused by severe stenosis of the larynx. They are manifested by a progressive feeling of suffocation, fear and motor restlessness on the part of the child, severe shortness of breath, a characteristic cough, perioral cyanosis and pallor of the rest of the skin.

Complications of false croup

Violation normal breathing in case of false croup with degree II-III stenosis, it leads to the addition of bacterial flora and the formation of purulent-fibrinous films on the walls of the larynx. The spread of infection down the respiratory tract causes the development of acute tracheobronchitis, obstructive bronchitis and pneumonia. Complications of croup can also include sinusitis, otitis media, tonsillitis, conjunctivitis, and purulent meningitis.

Diagnosis of false croup

False croup is diagnosed by a pediatrician or otolaryngologist on the basis of a typical clinical picture, medical history (the onset of the disease against the background of a respiratory tract infection), the results of examination of the child and auscultation of the lungs. Additionally, microlaryngoscopy and bacterial culture of a throat smear are performed to identify and identify the pathogen. bacterial nature. The establishment of chlamydial and mycoplasma flora, which in some cases causes false croup, is carried out PCR methods and ELISA. To detect a fungal infection, a smear is microscopyed and cultured on Sabouraud's medium. The severity of hypoxia, which accompanies false croup, is assessed by analyzing the ABS (acid-base state) and blood gas composition. Diagnosis of complications caused by false croup includes radiography of the lungs, pharyngoscopy, rhinoscopy, otoscopy and radiography of the paranasal sinuses.

Differential diagnosis of false croup

False croup must first be differentiated from true croup. Diphtheria croup is characterized by a gradual and progressive increase in laryngeal stenosis, accompanied by dysphonia up to complete absence vote. False croup can occur with voice disturbances, but there is never aphonia with it. True croup is characterized by a lack of amplification of the voice when crying or screaming. In patients with false croup, voice enhancement remains. Diphtheria croup can be diagnosed by identifying diphtheria deposits during examination of the larynx and detecting the causative agent of diphtheria during bacteriological examination of smears.

False croup is also differentiated from other diseases that may be accompanied by laryngeal stenosis. This allergic edema larynx, laryngeal foreign body inhalation. False croup, accompanied by a nonproductive cough, is an indication for the prescription of antitussive medications (codeine, licorice root, thermopsis, oxeladine, prenoxdiazine).

Antihistamines are used (mebhydrolin, diphenhydramine, hifenadine), which have an antitussive and decongestant effect. False croup with severe laryngeal stenosis is treated with glucocorticoid drugs, sedatives and antispastic agents. Taking antibiotics is recommended from the first day of the disease with bacterial false croup or when it develops infectious complications. Treatment for false croup of a viral nature is carried out with antiviral drugs.

The attacks accompanying false croup are caused by a reflex spasm of the larynx and can be stopped by attempts to evoke an alternative reflex. To do this, press on the root of the tongue, provoking gag reflex, or tickle your nose, causing reflex sneezing. Hot ones are also used foot baths, warm compresses on the larynx and chest, cans on the back.

Prognosis for false croup

Timely diagnosed false croup has a favorable prognosis and usually ends with adequate therapy full recovery. False croup, treatment of which was started in the decompensation stage, can be accompanied by severe complications and progress to the terminal stage, often ending in death.

Croup in children (stenotic laryngitis) is clinical syndrome, which occurs as a complication of certain infectious and inflammatory diseases of the upper respiratory tract and is manifested by inspiratory shortness of breath, barking cough, and hoarseness of voice.

Source: uzi-center.ru

Croup is most often observed in children under 6 years of age. This is due to age characteristics the structure of the larynx (loose submucosal tissue, cone-shaped) and its innervation.

Reasons

Croup in children develops against the background of infectious and inflammatory diseases accompanied by damage to the mucous membrane of the pharynx and trachea, for example, with influenza, adenovirus infection, measles, scarlet fever, chicken pox, diphtheria.

True croup develops as a result of swelling of the vocal folds (cords). The only example of this pathology is diphtheria stenotic laryngitis.

Obstruction of the respiratory tract during croup develops gradually, in stages and is associated with the direct effect on the mucous membrane of infectious agents and their waste products. Its final stage is asphyxia.

The pathological mechanism of croup development in children is based on the following processes:

• reflex spasm of the muscles that narrow the larynx (constrictors);
• swelling of the inflamed mucous membrane of the larynx;
• hypersecretion of viscous thick mucus.

Obstruction of the respiratory tract that occurs with croup in children makes it difficult to breathe, resulting in an insufficient amount of oxygen entering the lungs for normal breathing. In turn, this leads to hypoxia – oxygen starvation of all organs and tissues of the body.

The general condition of children with croup directly depends on the severity of obstruction. On initial stages Compensation for the resulting difficulty in breathing is carried out due to more intense work of the respiratory muscles. A further decrease in the lumen of the larynx is accompanied by a compensatory breakdown and the appearance of paradoxical breathing, in which rib cage expands as you exhale and contracts as you inhale. The final stage of croup in children is asphyxia, which leads to death.

Species

Croup in children, depending on the level of damage to the larynx, is divided into true and false. True croup develops as a result of swelling of the vocal folds (cords). The only example of this pathology is diphtheria stenotic laryngitis. With false croup in children, inflammatory swelling of the mucous membrane of the subglottic (subglottic) area of ​​the larynx of non-diphtheria etiology is observed.

According to the etiology of the underlying disease, false croup in children is divided into the following types:

• viral;
• bacterial;
• fungal;
• chlamydial;
• mycoplasma

With timely initiation of treatment for croup in children, the prognosis is favorable, the disease ends in recovery.

According to the severity of obstruction, the following degrees of croup in children are distinguished:

1. Compensated stenosis.
2. Subcompensated (incomplete compensation) stenosis.
3. Decompensated (uncompensated) stenosis.
4. Terminal phase (asphyxia).

By character clinical course croup in children can be uncomplicated or complicated. Complicated is characterized by the addition of a secondary bacterial infection.

Diphtheria, or true croup, according to the degree of prevalence of the inflammatory process, in turn, is divided into non-extended (limited to the vocal cords) and widespread (descending) croup, in which infectious process affects the trachea, bronchi.

Signs of croup in children

Clinical picture croup in children includes the following symptoms:

1. Noisy breathing (stridor). It is observed in croup of any etiology. The sound accompaniment of the act of breathing is associated with vibration vocal cords, arytenoid cartilages and epiglottis. As laryngeal stenosis increases, the sonority of respiratory sounds decreases, which is associated with a decrease in tidal volume.
2. Dyspnea. This is a mandatory symptom of croup in children. With subcompensated stenotic laryngitis, shortness of breath is inspiratory in nature, that is, the child experiences difficulty at the moment of inhalation. The transition of the disease to the decompensated stage is characterized by the appearance of mixed inspiratory-expiratory shortness of breath (both inhalation and exhalation are difficult). Fever body and rapid breathing during croup in children are accompanied by significant loss of fluid with the development of respiratory exicosis.
3. Dysphonia (change in voice). The development of this symptom of croup in children is associated with inflammatory changes in the vocal cords. With true croup, hoarseness of the voice gradually increases until it completely loses its sonority (aphonia). With false croup, aphonia never occurs.
4. Barking rough cough. Its occurrence is explained by incomplete opening of the glottis against the background of spasm. Moreover, what more swelling, the quieter the cough.

Croup in children can be complicated by the development of sinusitis, conjunctivitis, otitis media, pneumonia, bronchitis, and meningitis.

Diagnostics

Diagnosis of croup in children does not cause any difficulties and is carried out by a pediatrician or otolaryngologist based on the characteristic clinical picture of the disease, medical history, physical examination and laryngoscopy. If necessary, the child is consulted by an infectious disease specialist (diphtheria croup), a phthisiatrician (larynx tuberculosis), and a pulmonologist (bronchopulmonary complications).

When auscultating the lungs in children with croup, whistling dry rales are heard. The worsening of the disease is accompanied by the appearance of moist rales of various sizes.

When performing laryngoscopy, the degree of stenosis of the larynx, the extent of the pathological process, and the presence or absence of fibrinous films are determined.

To verify the pathogen, methods are used laboratory diagnostics: bacteriological culture and microscopy of throat smears, serological studies(RIF, ELISA, PCR). In order to determine the severity of hypoxia, the acid-base state of the blood and its gas composition are determined.

If complications are suspected, it is prescribed according to indications. lumbar puncture, radiography of the paranasal sinuses and lungs, rhinoscopy, otoscopy, pharyngoscopy.

Croup in children requires differential diagnosis with the following diseases:

• laryngeal tumors;
• epiglotite;
• foreign body of the larynx;
• congenital stridor.

Differential diagnosis of diphtheria croup and croup of other etiologies:

	True diphtheria croup	False croup
	Dry, rough, barking, dull, losing sonority, up to complete aphonia	Rough, barking, without losing sonority
	Dirty white, difficult to remove, leaving a bleeding surface after plaque removal	Superficial, easy to remove
Cervical lymph nodes	Enlarged, swollen on both sides, slightly painful, swelling of the tissue around the nodes	Enlarged, very painful, no swelling. Individual lymph nodes are palpated
Development of stenosis	Laryngeal stenosis develops gradually, initially noisy breathing, turning into an attack of suffocation. Doesn't go away on its own	Stenosis occurs suddenly, often at night. The inhalation is loud and can be heard from a distance. Sometimes stenosis resolves spontaneously

Differential diagnosis of true and false croup in children

The first symptoms of both true and false croup in children appear 2-3 days from the onset of the underlying disease. The clinical picture of true croup in children is characterized by a gradual increase in respiratory disorders.

Children with compensated forms of croup are subject to hospitalization in the department of acute respiratory infectious diseases infectious diseases hospital.

During the course of the disease, several stages are clearly visible:

1. Dysphonic. There is hoarseness of the voice, there are no signs of obstruction.
2. Stenotic. Against the background of increasing obstruction of the larynx, the child develops breathing difficulties and signs of hypoxia appear.
3. Asphyxial. Almost complete obstruction of the larynx occurs. Severe hypoxia causes the development of hypoxic coma and death.

With false croup in children, the attack occurs suddenly and mainly at night. During the day, the condition of patients changes significantly.

With true croup, the vocal cords themselves swell in children, and therefore the sonority of the voice gradually decreases until complete aphonia (silent crying, screaming). Although false croup is accompanied by hoarseness of the voice, aphonia never develops with it. When crying and screaming in children with false croup, the sonority of the voice is preserved.

With true croup in children, laryngoscopy reveals swelling and hyperemia of the laryngeal mucosa, a decrease in its lumen, and the presence of diphtheria films. Diphtheria plaques are difficult to remove, with the formation of small ulcers underneath. The observed laryngoscopic picture with false croup is different. It is characterized by:

• redness and swelling of the mucous membrane;
• accumulation of thick sputum;
• laryngeal stenosis;
• easy to remove plaque.

Carry out final differential diagnosis between false and true croup in children it allows bacteriological examination throat swab. When diphtheria bacilli are isolated from the test material, the diagnosis of true croup is beyond doubt.

Treatment of croup in children

Children with compensated forms of croup are subject to hospitalization in the department of acute respiratory infectious diseases of an infectious diseases hospital. In sub- and decompensated forms, treatment of children should be carried out in specialized emergency departments under the supervision of an otolaryngologist and resuscitator.

Prevention of true croup is based on mass vaccination of children against diphtheria in accordance with national calendar immunization.

Treatment of croup in children is based on the following principles:

• children are placed in rooms with an air temperature of no more than 18 °C;
• for true croup, anti-diphtheria serum is prescribed intravenously or intramuscularly;
• antibiotic therapy - indicated for children with true croup or false croup complicated by a secondary bacterial infection;
• inhalation therapy - carried out only for children with a preserved cough reflex;
• prescription of a short course of glucocorticosteroids (duration 2-3 days);
• antiallergic treatment - antihistamines should be prescribed with extreme caution to children with a pronounced hypersecretory component of inflammation);
• detoxification therapy ( intravenous administration solutions of electrolytes, glucose) – aimed at reducing the severity of intoxication syndrome, correcting water and electrolyte disorders caused by respiratory exicosis;
• when dry nonproductive cough antitussives are prescribed, and in case of damp conditions – mucolytics;
• prescribing antispasmodics to eliminate reflex spasm of the pharyngeal constrictor muscles;
• sedative therapy for severe agitation of the child;
• when signs of hypoxia appear, oxygen therapy is performed (inhalation of humidified oxygen through a face mask or nasal catheters, placing the child in an oxygen tent);
• in case of ineffectiveness conservative treatment croup in children accompanied by severe respiratory failure, tracheal intubation or tracheostomy is performed.

All parents, without exception, dream of their children growing up strong and healthy. But, unfortunately, these dreams do not always come true. Both adults and children get sick periodically. But, you see, childhood illnesses can worry mom and dad much more than their own ailments. Especially if the child is still very young, and the illness progresses rapidly, leaving no time for reflection and decision-making. For example, what happens when false croup is diagnosed in children. An attack of this disease can throw anyone off balance. And panic, in this case, is not the best assistant. So it turns out that the wisest thing to do would be to arm yourself with information about how to act if inflammation of the laryngeal mucosa, or false croup, develops in your baby. After all, this disease cannot be called rare. Especially in children early age.

What is OSLT?

If a child in the middle of the night (there are also attacks during the day, but less often) suddenly begins to cough, and his cough is barking or croaking, and his breathing is difficult when inhaling and is accompanied by wheezing, we can assume that he has - attack of false croup .

Croup, in his classic look, observed in diphtheria. False croup has similar symptoms, but the reasons for its development are different.

With diphtheria, the patency of the respiratory tract is impaired due to the formation of specific dense films in upper section air duct. And with false croup, the child’s breathing becomes difficult due to swelling of the mucous membrane and loose fiber larynx and trachea.

In the depths of the larynx, under the vocal cords, connective tissue quite richly supplied with lymphatic and blood vessels. Therefore, the larynx tends to react very actively with swelling to any irritant: be it or.

Laryngeal stenosis is popularly called false croup. Depending on its location, there is acute stenosing laryngitis (OSL) and acute stenosing laryngotracheitis

Due to the fact that in young children the lumen of the larynx is not yet large at all, it is they who are most often susceptible to attacks of false croup. And the older the child gets, the less likely it is to develop this disease.

False croup (larynx stenosis) or subglottic laryngotracheitis, or ALS (acute stenosing laryngitis), or OSLT (acute stenosing laryngotracheitis) - depending on the location of inflammation and edema - this is inflammation of the mucous membrane of the upper respiratory tract (larynx, trachea), which results in a narrowing of the lumen of the larynx.

This inflammation develops as a result of a viral or bacterial infection entering the baby’s respiratory tract. It is the infection that causes the inflammatory process, swelling and increased production of mucous secretion in the subglottic space, vocal cords and trachea.

The cause of laryngeal edema can also be allergic reactions of the baby to various irritants entering his body from the outside.

That is, OSL (OSLT) is considered as independent disease, not entirely correct. It is, rather, a group of diseases, or a consequence of allergies, acute respiratory viral infections, acute respiratory infections, parainfluenza, adenovirus infection, tonsillitis, scarlet fever, etc.

But an important role is also played here by the factor of the child’s physiological predisposition to.

False croup is, rather, a consequence or complication of an infectious disease or an allergic reaction of the body

When can a child get false croup?

It is the anatomical and physiological characteristics of the respiratory tract of young children that explain the fact that they are most often exposed to attacks of false croup.

• Short vestibule, funnel-shaped and small diameter of the lumen of the larynx.
• Softness of the cartilaginous skeleton.
• Disproportionately short vocal folds, located, moreover, too high.
• Increased sensitivity, hyperexcitability of the muscles that close the glottis.
• Functional immaturity of the respiratory system, etc.

All this - objective factors development of OSLT. Among the subjective reasons are:

• IUGR (intrauterine growth retardation).
• Prematurity.
• Birth injuries.
• Childbirth by caesarean section.
• Anomalies of the constitution.
• ARVI, acute respiratory infections and other infectious diseases.
• Allergic reactions.
• Post-vaccination period.
• Hit foreign bodies into the respiratory tract.
• Laryngeal injuries.
• Laryngospasm.

Most often, false croup occurs in children in the 2nd – 3rd year of life. In infants (6-12 months) - somewhat less frequently. Very rarely - after 5 years. And never in the first 4 months after the birth of a child.

Laryngeal stenosis may be varying degrees severity and is characterized by paroxysmal course

Degrees of subglottic laryngotracheitis

Laryngeal stenosis, depending on the severity of its occurrence, can be:

I degree or compensated. Lasts from several hours to 2 days. There is an increase in the depth and frequency of inhalations with physical activity or anxiety. There are no signs of excess carbon dioxide in the blood. Gas composition blood is maintained due to the compensatory efforts of the body.

II degree or subcompensated. Lasts up to 3-5 days. There is constant shortness of breath, increased clinical symptoms laryngeal stenosis. Compensation for the lack of oxygen occurs by increasing the work of the respiratory muscles by 5-10 times. The child is restless and excited. The first signs appear oxygen deficiency: blue discoloration of the nasolabial triangle, pallor of the skin, tachycardia.

III degree or decompensated. Increased work of the respiratory muscles no longer compensates oxygen starvation. There is constant shortness of breath. Rough wheezing can be heard over the lungs. The voice is hoarse. Signs of hypoxia intensify: tachycardia, arterial hypotension, loss of pulse wave on inspiration.

IV degree or asphyxia. Extremely serious condition. Obstructive respiratory failure leads to toxicosis of the body. Breathing becomes frequent and shallow. Convulsions may occur and body temperature drops. Bradycardia occurs. The child may fall into a coma. Deep combined acidosis develops.

As you can see, subglottic laryngotracheitis is a very serious disease. This means that it must be taken seriously. Immediately after detecting the first symptoms of OSLT, call an ambulance and provide first aid to the baby.

Symptoms of false croup in children: barking cough, hoarse voice, shortness of breath, anxiety

False croup in children: symptoms

• False croup usually develops against the background of colds or infectious diseases, allergic reactions.
• An attack of OSLT most often begins at night. When the child is in a horizontal position, in his respiratory tract phlegm accumulates, which irritates them, causing them to cough.
• Body temperature may rise.
• The baby's cough is dry, similar to the croaking of a crow or the barking of a dog.
• The child's voice becomes hoarse or disappears completely.
• The baby begins to breathe frequently and noisily. When you inhale, you can hear rough wheezing.
• The baby is worried and scared. What causes the symptoms? the diseases are only getting worse.
• Due to lack of oxygen, blueness of the nasolabial triangle and pallor of the skin are observed.

During an attack of false croup, a child can take up to 50 breaths per minute. The norm is 25-30 (for children aged 3 to 5 years).

This is how the body tries to compensate for the lack of oxygen caused by the narrowing of the lumen of the larynx. If you do not provide help to your baby in time, he may lose consciousness or even suffocate.

What should be done if signs of false croup are detected in a child?

Even if you know how to help your child during an attack of acute respiratory syndrome, you must call an ambulance

First aid

Remember, only a doctor can accurately determine the severity of laryngeal stenosis. And if the ambulance crew insists on hospitalizing the child, you definitely need to listen to their opinion. After all, OSLT is characterized by an undulating course, which means that attacks of the disease can recur again and again.

Inhalations with a baking soda solution help relieve spasms and thin mucus.

What can't you do?

Some of your actions during an attack of false croup can only worsen the child’s condition. Although it will seem to you that you are helping the baby. Such help is effective for acute respiratory viral infections or acute respiratory infections, but not for subglottic laryngotracheitis. What are we talking about?

1. It is forbidden wrap the baby up, thereby exacerbating breathing problems.
2. It is forbidden give him cough suppressants. The child must cough to cough up mucus that is blocking the passage of air into the lungs.
3. It is forbidden use rubbing or mustard plasters with essential oils. Strong odors can cause spasm of the larynx.
4. It is forbidden Offer your baby tea with honey, raspberries, and medicinal herbs. To avoid allergic reactions in the child. This will only increase laryngeal swelling.

Only a doctor can accurately determine the severity of stenosis

Treatment of the disease

Medical treatment of false croup is determined by the severity of the disease, the presence accompanying pathologies and risks of complications.

It includes distraction therapy, alkaline inhalations, sedatives, antihistamines and antispastic drugs, and in the case of concomitant infections, antibiotics.

In case of fourth degree laryngeal stenosis, intubation or tracheostomy is indicated. But these are extreme measures, which are very rarely reached. Drug treatment is usually sufficient.