Symptoms and treatment of false croup in children. False croup in children, symptoms and treatment

False croup (acute laryngeal stenosis, laryngotracheitis) is a special condition that develops mainly against the background of acute respiratory infections. It is called false in order to differentiate it from true croup, which develops with diphtheria and has similar symptoms (difficulty breathing, barking cough, hoarseness). Most often, children 1-5 years old are affected by laryngotracheitis.

The disease can be life-threatening for the child, so at the first sign of it, urgent qualified help is needed.

Reasons for appearance

In most cases, the development of false croup is facilitated by viral infections:

flu;
adenovirus;
herpes.

Laryngotracheitis of a bacterial nature is less common, but it occurs in children in more complex forms than the viral one. Bacteria that can cause false croup:

hemophilus influenzae;
staphylococci;
streptococci;
pneumococci.

The disease can occur as a complication:

tonsillitis;
rhinitis;
adenoiditis;
after vaccination.

A special risk group includes children who are overweight and prone to allergic reactions. False croup often develops in children who have had:

birth injury;
hypoxia;

The peak incidence of laryngotracheitis in children under 5 years of age is due to the anatomical features of the structure of their respiratory organs. According to statistics, girls suffer from false croup less often than boys. After 6-8 years, children “outgrow”, false cereals disappear.

Classification and types of disease

By its nature, acute laryngeal stenosis can be viral or bacterial. According to the flow - complicated and uncomplicated.

There are 4 degrees of false croup:

compensated (1st degree)– characterized by difficulty in inhaling during physical activity or stress;
subcompensated (2nd degree)– difficulty breathing is observed even in a calm state;
decompensated (3rd degree)– characterized by heavy paradoxical breathing, severe shortness of breath;
terminal (4th degree)– a severe attack with hypoxia, which can be fatal.

Symptoms

Mostly, acute laryngeal stenosis occurs against the background of acute respiratory infections. Signs of the disease appear a few days after the onset of acute respiratory infections. This usually happens in the evening. During the daytime, the child may have a fever or runny nose. In the evening the breathing pattern changes. It becomes bubbling, whistling and labored (stridor), making it difficult for the child to breathe and lacking oxygen.

The greater the swelling of the larynx, the louder the noise becomes when inhaling and exhaling. A harbinger of stridor in many cases is a dry, barking cough. Hoarseness can be considered a symptom of laryngotracheitis if it is accompanied by stridor. In other cases, it is considered a sign of laryngitis, which occurs without significant swelling of the larynx.

In addition, symptoms characteristic of colds are observed:

general weakness;
joint pain;
enlarged cervical lymph nodes;
increased body temperature;
lethargy.

With degree 4 stenosis, the symptoms are as follows:

stopping barking cough;
disappearance of breathing noise;
decrease in pressure;
arrhythmia and weakness of breathing;
There are convulsions and bradycardia.

The child's consciousness becomes confused and he may faint. Without timely emergency measures, asphyxia is possible.

Acute laryngeal stenosis must be differentiated from bronchial asthma. With false croup, inhalation is very difficult, and the noise when exhaling is almost inaudible. Asthma attacks, on the contrary, are accompanied by free inhalation and difficult wheezing exhalation.

Diagnostics

To identify false croup and begin proper treatment in a timely manner, an ENT specialist or pediatrician prescribes a thorough examination of the patient. He examines the child’s larynx and listens to the airways.

Conducted:

microlaryngoscopy;
bacterial seeding of material from the throat;
otoscopy;
X-ray of the lungs and sinuses;
rhinoscopy;
pharyngoscopy;
blood tests (PCR and ELISA, gas composition).

Treatment methods

It is advisable to carry out treatment in a hospital; attacks of false croup are very dangerous. Be prepared to provide first aid to your child.

Important! At the first symptoms of acute laryngeal stenosis, you must call an ambulance. Swelling of the larynx can be life-threatening for the child.

On our website you can learn about other diseases of the ENT organs in children. Read about sinusitis; written about catarrhal sore throat; Find out the articles about what to do if your child has ear pain. There is a page written about tracheitis; We have an article on treating a runny nose with folk remedies.

First aid during an attack

Before providing qualified medical assistance, parents should take measures to alleviate the baby’s condition:

Calm the child and put him on the bed. The upper part of the body should be on a hill. A regular pillow will do.
Open the window, humidify the air in the room (with a humidifier or using wet towels);
Free the child from constrictive clothing that constricts the chest.
Give the child a warm alkaline liquid (2% soda solution or Borjomi) to drink. This will help moisturize the mucous membranes and make phlegm thinner.
Inhale with mineral water. It's good to use a nebulizer. (Read the article for more information about inhalation with a nebulizer).
Place vasoconstrictor drops into the nose.
To relieve swelling, you can give an antihistamine (Erespal, Fenistil).
In case of temperature and fever, give an antipyretic (Nurofen, Paracetamol).
If breathing stops, induce vomiting. This will stimulate the respiratory center.

Drug therapy

After the ambulance arrives, the doctor will assess the severity of the child’s condition and determine his treatment regimen. In case of severe attacks, you cannot risk the child’s health and hospitalize him in a hospital.

Therapeutic measures for stage 1 false croup:

good air supply;
drinking plenty of warm water frequently;
mustard plasters on the calf muscles;
inhalations with sodium bicarbonate solution, vitamin A, hydrocortisone, aminophylline;
taking antispastic drugs (Papaverine, Atropine);
taking hyposensitizing and sedative drugs (Pipolfen, Diphenhydramine);
vitamin therapy.

If there is no effect from such treatment, a novocaine blockade is performed in the nose. It reduces swelling of the mucous membranes and relieves reflex spasm. For fever at stage 1 of laryngotracheitis, antibiotics are prescribed.

False croup grade 2 is treated in the same way as grade 1. Additionally used:

humidified oxygen;
hypertonic solutions of glucose and calcium gluconate are administered intravenously to relieve edema;
hormonal therapy (Hydrocortisone, Prednisolone);
cardiac solutions are prescribed intravenously (Korglikon, Strophanthin);
neuroleptic drugs (Promazine, Aminazine).

For grade 3 stenosis, Prednisolone is administered intravenously. The first dose should be ½ daily. They expand the intake of cardiac medications and give sodium oxybutyrate.

Broad-spectrum antibiotics are administered:

Tetraolean;
Tseporin.

If there is no result from treatment, laryngoscopy is performed. During the procedure, mucus and blood crusts are sucked out using a polyethylene catheter. Then the mucous membrane is lubricated with ephedrine, hydrocortisone, vaseline or peach oil. Sometimes bronchoscopy is indicated. During this procedure, the bronchi are washed, pus and mucus are removed, and antibiotics are administered intratracheobronially.

If all measures are ineffective or the child has severe progressive 4th degree stenosis, intubation or tracheostomy is indicated.

Read here about how to make a gauze diaper for a newborn with your own hands.

Prohibited actions

Laryngotracheitis is especially dangerous for children who are prone to allergies, overly excitable, and with lymphoid growths in the nasopharynx. Therefore, therapy for them must be selected with caution. Adviсe:

In order not to increase swelling in allergy sufferers, you should not give citrus juice, honey, or raspberry jam.
To avoid causing spasms of the laryngeal muscles, do not use essential oils or mustard plasters.
There is no need to rush to give antitussives. A wet cough is a protective function of the body. When you cough, phlegm containing harmful toxins is expelled.

Prevention measures

Since false croup in most cases is a consequence of colds and viral diseases, preventive measures are effective to help prevent them:

harden the child;
strengthen immunity; (Find out articles on how to increase a child’s immunity using folk remedies);
provide adequate nutrition;
use natural phytoncides;
carry out vitamin therapy during seasonal colds;
do not overcool the child;
observe the rules of hygiene;
Ventilate the child’s room more often and humidify it.

False croup is a common condition in children, which is facilitated by the anatomical structure of their respiratory organs. It can occur with every manifestation of an acute respiratory infection. Therefore, parents should be prepared for an attack and provide all available means to stop it. You definitely need to call an ambulance with symptoms of false croup, since there is a risk of complications, including asphyxia.

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 young children.

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 its classic form, is observed in diphtheria. False croup has similar symptoms, but the reasons for its development are different.

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

In the depths of the larynx, under the vocal cords, the connective tissue is 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, it is not entirely correct to consider ALS (OSLT) as an independent disease. 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 these are objective factors in the 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.
Entry of 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 can be of varying degrees of severity and is characterized by paroxysmal progression.

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 during physical activity or anxiety. There are no signs of excess carbon dioxide in the blood. The gas composition of the 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 and increased clinical symptoms of 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 of oxygen deficiency appear: blue discoloration of the nasolabial triangle, pale skin, tachycardia.

III degree or decompensated. Increased work of the respiratory muscles no longer compensates for 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 during 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, restlessness

False croup in children: symptoms

False croup, as a rule, develops against the background of colds or infectious diseases, allergic reactions.
An attack of OSLT most often begins at night. When a child is in a horizontal position, phlegm accumulates in his respiratory tract, which irritates them, causing a 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. This is why the symptoms of the disease only get worse.
Due to lack of oxygen, the nasolabial triangle turns blue and the skin becomes pale.

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 the baby is not helped 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, an ambulance must be called

First aid

The very first thing you should do when you notice the symptoms listed above in your baby is call an ambulance. OSLT attacks usually last no more than 30-40 minutes. And, if you know what to do in such cases, then you can help the child yourself. But sometimes the disease develops very rapidly. And qualified medical action may be required. If the lumen of the larynx is severely narrowed, doctors perform intubation to restore the airway and ensure the flow of air into the lungs.
The baby should be placed in a semi-sitting position. Make sure nothing is blocking his breathing. Free the child from clothing that is constricting the chest.
Give the baby a warm alkaline drink (milk with soda, Borjomi, etc.). It thins mucus and prevents dehydration.
Swelling of the loose tissue of the larynx is well helped by antihistamines: claritin, cetrin, suprastin, etc. Give the child one of them, observing the age-specific dosage indicated in the instructions for use.
The room where the baby with laryngeal stenosis is located needs to be well ventilated.
If the toddler's temperature is higher than normal, antipyretics can be used.
While waiting for the ambulance to arrive, try to calm and distract the baby. Try to maintain peace of mind yourself. Remember, the child feels your fear. But excitement and, especially, crying are categorically contraindicated for him.
Due to the fact that during an attack of false croup the baby experiences oxygen starvation, it is necessary to ensure access to fresh air in the room where he is located.
Also take care to humidify the air in the room. If you don’t have a special humidifier, boil water in a wide saucepan and place it next to the baby. Let him breathe in the steam, but the steam should not be hot. You can hang wet towels around the room.
If you have an inhaler, give your baby a soda solution.
Use any means available to you to humidify the air in the room.
Warm foot baths or mustard plasters on the calf muscles will help activate the flow of blood from the swollen larynx to the feet. They will also calm and distract the child.
To clear your baby's airways of sticky mucus, press a teaspoon onto the root of his tongue. This way you stimulate the cough center. But in the same way you can make the baby vomit. This is not bad at all: mucus will also come out with the vomit, which, in fact, is what you achieved with your actions.

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 assistance is effective for acute respiratory viral infections or acute respiratory infections, but not for subglottic laryngotracheitis. What is it about?

It is forbidden wrap the baby up, thereby exacerbating breathing problems.
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.
It is forbidden use rubbing or mustard plasters with essential oils. Strong odors can cause laryngeal spasms.
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 of concomitant pathologies and the 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.

Very often, false croup entails complications such as sinusitis, otitis media, tonsillitis, bronchitis, pneumonia, and even purulent meningitis. Therefore, in no case should you neglect preventive measures to prevent the occurrence of the disease.

With subglottic laryngotracheitis, taking antihistamines helps relieve swelling of the mucous membrane and loose tissue of the larynx

Prevention

Healthy eating, long walks in the fresh air, observance, exercise. All this helps to increase the child’s body’s resistance to any disease.
Devices such as an inhaler (preferably a nebulizer) and a humidifier will be a useful purchase for the whole family.
It is advisable to show the child to an immunologist and allergist. Preventive measures prescribed by these specialists can reduce the likelihood of repeated attacks of OSLT significantly.

An air humidifier will be a useful purchase not only for a child suffering from attacks of false croup, but also for all members of your family

Hardening and general strengthening measures are mandatory for children who often suffer from colds and respiratory infections. Pay more attention to prevention, and you won’t have to deal with treatment later...

Video “Laryngitis and croup” (Komarovsky)

If for an adult an acute respiratory viral infection, or as it is popularly called a “cold,” goes away in a week, without causing, in addition to snot and malaise, and maybe a cough, any special troubles, then for children it is not such a simple disease. Or rather, a group of diseases. The danger lies in the addition of complications, one of which (it is also one of the most dangerous) is false croup. More precisely, this disease is correctly called acute stenosing laryngitis (OSL) or laryngotracheitis (depending on whether only the larynx or larynx is affected, it is “larynx” and trachea in Latin), it is also sometimes called subglottic laryngotracheitis. In the future, with your permission, I will use the abbreviation OSLT. I think the decoding is already clear.

Croup (from the English Scottish croup - to croak) is an inflammation of the mucous membrane of the larynx, accompanied by wheezing, barking or croaking cough and difficulty breathing (mainly during inspiration). False croup is so named in order to distinguish it from true croup, which is observed in diphtheria and has similar symptoms. With diphtheria, the obstruction of the airways, and therefore the difficulty of air passage, is caused by specific dense films and there is no swelling, and the cause of false croup is swelling of the mucous membrane and loose tissue of the larynx and trachea.

False croup is a viral disease of the upper respiratory tract. The infection causes inflammation, swelling and increased production of mucous discharge in the tracheal area in the subglottic space in the area of the vocal cords. Usually the disease goes away on its own, however, 5 - 10% of children will still need hospitalization. Therefore, there is no need to do anything on your own; always call an ambulance. Most often, croup or OSLT develops in children of the second and third year of life, somewhat less often - in infancy (6 - 12 months) and in the fourth year of life. OSLT rarely occurs in children over 5 years of age and never in the first 4 months of life.

In the occurrence of stenotic laryngitis and laryngotracheitis, the leading role belongs to influenza viruses, parainfluenza, adenoviruses and respiratory syncytial, as well as viral-viral associations. The overwhelming factor causing the inflammatory process in the larynx and trachea, accompanying the development of croup syndrome, is the parainfluenza virus. It accounts for approximately half of all viral OSLTs. Along with viruses, bacterial flora, activated during ARVI or added as a result of nosocomial infection, plays an important role in the development of an unfavorable (severe, complicated) course of OSLT.

Anatomical and physiological features of the children's larynx and trachea (because of them, croup occurs): small diameter, softness and pliability of the cartilaginous skeleton; short narrow vestibule and funnel-shaped larynx; highly located and disproportionately short vocal folds; hyperexcitability of the muscles closing the glottis; functional immaturity of reflexogenic zones and hyperparasympathicotonia. In the mucosa and submucosa there is an abundance of lymphoid tissue with a large number of mast cells, blood vessels and weak development of elastic fibers. Unfavorable background factors also play a role: constitutional anomalies (exudative-catarrhal and lymphatic-hypoplastic diathesis); drug allergies; congenital stridor; paratrophy (obesity); birth trauma, birth by caesarean section; post-vaccination period; sensitization by previous frequent acute respiratory viral infections.

When can a child “catch” the disease?

In the off-season. In winter, everything is clear to parents - it’s frosty outside, they need to dress their child warmer. And with the onset of spring, I really want to throw off my heavy clothes as soon as possible! But the first rays of the sun are deceptive, the air is still cold - and the baby becomes a victim of ARVI. Where there are respiratory diseases, there is false croup. Or, on the contrary, the warmth has already arrived, and caring mothers are still wrapping their baby up in winter. But on a walk, children either run around like clockwork or sit in the sandbox - and it’s easy for a sweaty child to catch a cold! From this point of view, thaws in the middle of winter are also dangerous.

A virus (most often it is parainfluenza virus type 1, as well as RS virus, adenovirus, influenza viruses, measles), once on the mucous membrane of the larynx, causes its inflammation - laryngitis. Against the background of inflammation, mucus accumulates in the lumen of the larynx, swelling of the fatty tissue and a reflex spasm of the glottis occurs, which leads to a narrowing of the lumen of the larynx (larynx stenosis) and, as a result, a sharp difficulty in breathing.
What does it look like? The first manifestations of croup are always sudden. As a rule, they happen at night when the child is already sleeping. And this frightens both the child and his parents even more. During the day, you might notice a slight hoarseness in your breathing, but it is so insignificant that it is barely perceptible to the ear. In the evening, the child becomes lethargic - but who doesn’t become like that after an active day, especially after a long walk? In fact, at this time the virus is already active in the body. In his sleep, the child tosses and turns, finds it difficult to breathe (after all, swelling of the throat has already begun), and he begins to cough. The cough with croup is very characteristic - dry, “barking” or “croaking”. The child breathes more often than usual, up to 50 breaths per minute (the norm at the age of 3-5 years is 25-30). This is how the body tries to make up for the lack of oxygen. The temperature may rise. Very quickly the cough becomes more and more severe, and if at this time the child does not wake up and the parents do not provide urgent assistance, then there is a high probability of loss of consciousness and suffocation!

OSLT disease comes in 4 degrees:

1st degree stenosis (compensated). Clinically characterized by all the signs of OSLT. With anxiety and physical exertion, there is an increase in the depth and noise of breathing, and inspiratory shortness of breath appears. There are no clinical signs of hypoxemia (excess carbon dioxide in Corvi). Through compensatory efforts of the body, the gas composition of the blood is maintained at a satisfactory level. The duration of laryngeal stenosis ranges from several hours to 1-2 days.

Stenosis of the 2nd degree (subcompensated). Strengthening of all clinical symptoms of OSLT. The characteristic stenotic breathing is clearly audible at a distance and is observed at rest. Inspiratory shortness of breath is constant. Compensation for stenosis occurs by increasing the work of the respiratory muscles by 5-10 times. There is a retraction of the compliant areas of the chest at rest, which increases with tension. Children are usually excited, restless, and their sleep is disturbed. The skin is pale, perioral (around the mouth) cyanosis appears, intensifying during a coughing attack, and tachycardia. The symptoms of 2nd degree laryngeal stenosis can persist for a longer time - up to 3-5 days. They can be constant or have a paroxysmal nature.

Stenosis of the 3rd degree (decompensated). It is characterized by signs of respiratory decompensation and circulatory failure, a sharp increase in the work of the respiratory muscles, which does not prevent the development of hypoxemia, hypoxia, and hypercapnia. External and tissue respiration is disrupted, the level of oxidative processes in tissues decreases, and mixed acidosis appears. The general condition is serious. Severe anxiety, accompanied by a feeling of fear, is replaced by lethargy and drowsiness. The voice is sharply hoarse, but complete aphonia is not observed. The cough, initially rough and loud, becomes quiet and superficial as the narrowing of the lumen of the larynx increases. Shortness of breath is constant, mixed. Breathing is noisy, frequent, with a sharp retraction of the yielding areas of the chest. In this case, you should pay attention to the severity of the retraction of the lower end of the sternum, which can appear already in the 2nd degree and sharply intensifies in the 3rd degree of laryngeal stenosis. As stenosis increases, breathing becomes arrhythmic, with uneven depth and paradoxical excursions of the chest and diaphragm. Noisy, deep breathing is replaced by quiet, shallow breathing. Clinical signs of hypoxemia are evident. Auscultation above the lungs first hears rough wheezing of a wirey nature, then a uniform weakening of breathing. Heart sounds are muffled, tachycardia, paradoxical pulse (loss of pulse wave on inspiration). Arterial hypotension may be recorded.

4th degree stenosis (asphyxia). The condition is extremely serious, a deep coma develops, there may be convulsions, the body temperature drops to normal or subnormal levels. Breathing is rapid, shallow or arrhythmic with periodic apneas. Heart sounds are muffled, bradycardia occurs, and then asystole. Hypoxemia and hypercapnia reach extreme values, and deep combined acidosis develops.
In addition to obstructive respiratory failure, the severity of the condition is determined by the severity of toxicosis and the addition of complications. I wrote all this to you not to scare you with horror stories, but so that you realize that croup cannot be treated on its own, it is dangerous for the baby’s life. Call a doctor in any case, even if you think the attack has already passed. OSLT is prone to relapses (repetition of an attack), and may become more severe.

How to get ahead of an attack and what to do?

The first and most important thing is to calm down yourself and calm the child. The child's excitement and crying intensify the cough, which, in turn, intensifies the manifestations of croup, forming a “vicious circle.”
Already when the first symptoms appear (difficulty wheezing, wheezing, the first hesitant cough), it is necessary to pay attention to the climate in the room. There should always be fresh air in the house - ventilate the rooms as often as possible. False croup is a disease in which fresh air is your assistant. After all, it helps saturate the blood with oxygen.
The child must be placed in an elevated position, half sitting, with pillows or a blanket under his head and shoulders.

Free him from restrictive clothing. Unbutton all the collars of your shirt so that nothing can restrict your chest.

Give the child warm liquid to drink. With croup, a child loses fluid quite easily. Therefore, it is very important to give your child water all the time. It is better to give juices than milk. Drinking frequently thins mucus and prevents dehydration.

Don't forget about hydration. Inhalations are one of the main means in the fight against false croup, and a humid atmosphere in the apartment is a serious preventive measure. It’s good if you already have a humidifier in your home, but if you haven’t made this useful purchase yet, you can make do with improvised means. Wet rags on batteries and water containers in each room are suitable.

Apply mustard plasters to the area of the calf muscles. This will redistribute the blood to the legs and distract it from the larynx, and therefore prevent the swelling from getting worse.

If a child has a high temperature, give an antipyretic in an age-appropriate dose.

Induce a gag reflex if breathing stops. This reflexively excites the respiratory center, which is located next to the vomiting center.

Antihistamines (anti-allergy) drugs - to remove the allergic reaction and relieve swelling.

Of course, if signs of false croup occur, you should immediately call an ambulance or take the child to the nearest hospital. Do not forget that even an attack that has passed easily can happen again and again. And its consequences are irreversible. While inhalation can still be performed at home, tracheal intubation is a complex procedure that requires special conditions and constant supervision by specialists. So if the doctor insists on hospitalization, it is better not to risk the child’s health and take him to the hospital.

Usually the attack lasts 20-30 minutes, and, gradually, the child’s condition improves. If it still hasn’t improved, then let’s hope that the ambulance you called has already arrived, and now professionals will help the child.

Medical treatment is determined by the severity of the stenosis, its duration, as well as the presence of toxicosis caused by ARVI, the age of the child, and his premorbid (pre-painful) state.
For stenosis of the 1st degree, the following is necessary: wide access of air; distraction therapy - mustard plasters on calves and circular hot baths at a water temperature of up to 38-39 degrees. C, plenty of frequent warm drinks (tea, Borzhom, milk with soda), steam alkaline inhalations (4% sodium bicarbonate solution with vitamin A, aminophylline, hydrocortisone); antispastic therapy (atropine, papaverine orally in age-related doses); sedatives and hyposensitizing agents (diphenhydramine, pipolfen, etc.), vitamins. If there is no effect, intranasal novocaine blockade is used, which helps reduce swelling of the laryngeal mucosa and relieve reflex spasm. Already at this stage of stenosis, especially in the presence of fever, it is recommended to prescribe antibiotics. It is advisable to place the child in a room where the air is humidified with steam.

For grade II stenosis, in addition to the above remedies, humidified oxygen is widely used; in order to reduce swelling of the mucous membrane of the respiratory tract - hypertonic solutions intravenously (20-30 ml of 20% glucose solution, 5-10 ml of 10% calcium gluconate solution); hormonal drugs: hydrocortisone, prednisolone; cardiac medications (strophanthin or corglycon intravenously or digoxin orally), diuretics; neuroleptics (aminazine, promazine, etc.).

For grade III stenosis, intravenous prednisolone (1.5-2 mg/kg), with the first dose being half the daily dose; cardiac drugs are more widely used; broad-spectrum antibiotics (ceporin, tetraolean, etc.), as well as sodium hydroxybutyrate (GHB). If there is no effect, a therapeutic laryngoscopy is performed, during which the mucus is sucked out with a polyethylene catheter, dry bloody crusts are removed, and the mucous membrane is lubricated with a solution of ephedrine, hydrocortisone, peach, apricot or petroleum jelly. Sometimes direct laryngoscopy is repeated several times. For grade III stenosis, therapeutic bronchoscopy is also indicated (removal of mucus, pus, crusts, bronchial lavage, intratracheobronial administration of antibiotics), but there must be full readiness for immediate tracheostomy.

If the measures listed above are ineffective, the severity of stenosis does not decrease, there is a tendency to progression of cardiovascular failure (paradoxical pulse is noted - loss of the pulse wave, adynamia, pallor of the skin increase against the background of persistent cyanosis of the lips, limbs, etc.), intubation or tracheostomy.

The prognosis for grade III stenosis and asphyxia is serious; in grades I-II and early treatment - favorable. I also listed this so that you understand how serious this disease is.
Prevention: prevention of ARVI, especially in children with allergic diathesis.

It should be noted that difficulty breathing due to laryngeal stenosis occurs not only with viral infections. The cause of stenosis can also be diphtheria (the so-called true croup, when diphtheria films formed on the mucous membrane of the larynx sharply narrow its lumen), a foreign body, allergic edema, laryngospasm (with a decrease in the level of calcium in the blood), etc. Therefore, only a doctor can establish the true cause difficulty breathing, correctly assess the patient’s condition and determine treatment tactics.

How to prevent croup?

Unfortunately, croup is a viral disease, therefore, antibiotics do not work for it, therefore, their prescription is not justified, as with other viral infections. Try to ensure that your child does not come into contact with patients suffering from any viral infections, follow the basic rules of hygiene, if there is a sick person in the house, if the child has an acute respiratory viral infection, try to give him water as often as possible. Do not use aromatic oils as inhalations, because... they can cause severe irritation to a child's respiratory tract. Do not smoke near your child, especially around a child who has a respiratory illness.

Acute stenosing laryngotracheitis is the official name of the disease in which compression of the larynx occurs, which occurs as a result of a viral infection. This disease has a second, more common name - false croup. Its symptoms, as a rule, manifest themselves in a hoarse voice, noisy breathing, a “barking” cough, cyanosis of the lips and a constant restless state of the child.

As a rule, attacks of the disease appear at night; false croup does not bother you during the day. This is due to the fact that at night swelling of the tissue under the ligaments occurs due to the flow of blood to it. Usually attacks can appear within two to three days, but sometimes the form of the disease becomes protracted.

False croup is extremely rare in adults; as a rule, this diagnosis is given to children. There is a logical explanation for this: the reason is the narrow lumen of the larynx in babies. As a result, swelling in the child occurs much faster and causes serious consequences in the form of breathing problems. In adults, there can only be true croup, which accompanies diphtheria.

As a rule, the child's condition is clear, he shows severe anxiety, as a result of which the cough and spasms intensify. The diagnosis of “false croup” at home can be made by examining the child’s throat: there is no plaque on the tonsils, the cervical lymph nodes are not inflamed or enlarged. Remember that false croup should not be confused with diphtheria, because different methods and techniques are used in the treatment of these diseases. With true croup, which is characteristic of diphtheria, there is no barking cough, but there is plaque on the tonsils.

It is important to provide first aid to a child when false croup (the symptoms of which you already know how to distinguish) appears at the initial stage. Doctors do not recommend giving any medications before their arrival if you are not sure of the cause of the attack. If you know what allergen caused it, you can give an antihistamine. It is allowed to give no-shpa, which relieves spasms. If the child's breathing is difficult and occurs with a characteristic whistle, this is a sign of increasing swelling. You cannot leave the baby for a second; you need to reduce the temperature in the room to 18 degrees and bring the humidity to 70% (which is easy to do if you have air conditioning).

You cannot use cups, steam your feet, or perform inhalations if the treatment is carried out, as a rule, in a hospital under the supervision of doctors. If the attack stops while providing first aid to the child, you cannot be sure that it will not recur with renewed vigor. Before the doctors arrive, the child should be given a warm drink, and the nose can be cleared to make breathing easier (this is especially important between coughing attacks).

Remember that false croup, the symptoms of which depend on the severity of the attack, must be prevented. To do this, the air humidity in the room where the child sleeps must be approximately 65-70%, viral infections must be treated in a timely manner, and allergic reactions, if the child has them, must be prevented by preventing the allergen from affecting the body. Also remember to regularly ventilate the room and harden your baby.

When treating false croup, in addition to taking medications and performing procedures prescribed by specialists, it is recommended to follow a special diet. It includes taking a regular multivitamin and controlling your intake of rutin, which is found in citrus fruits, black tea, apple peels and

A fairly common syndrome during a viral or, less commonly, bacterial respiratory tract infection is false croup in children. Its danger lies in the rapid and sometimes lightning-fast development, the need to take certain measures even before the arrival of the medical team. Children from one to 5 years of age are most susceptible to it, especially those who have suffered birth trauma, hypoxia during childbirth, or those who are artificially fed.

But even absolutely healthy, rarely ill children can suffer from false croup: an excessive immune response to the introduction of certain viruses and bacteria into the mucous membranes of the respiratory organs is assumed.

False croup is a lack of air intake into the child's body, caused by a narrowing of the glottis due to edema. A child’s larynx is narrow (from 0.5 cm), and during infection its walls thicken and swell, which significantly reduces the lumen of the windpipe. Increased mucus production in response to infection also reduces the diameter of the airway. In addition, a reflex spasm of the ligaments is often associated, which makes it difficult for air to enter the lungs.

The cause of false croup is catarrhal diseases: ARVI, and parainfluenza (most often), scarlet fever,. If microbes from the tonsils penetrate into the larynx during a sore throat, false croup of bacterial origin may develop. It occurs less frequently than viral cereals, but is no less difficult to tolerate.

Children prone to allergies are predisposed to developing croup during an infectious disease.

Important! Unlike true croup, when an obstacle to the movement of air is created by dense diphtheria films that block the throat, false croup occurs precisely because of the narrowing of the glottis.

Most often, false croup in children is an acute and ongoing condition. Subacute (gradually developing) course is observed in children with chronic processes - tonsillitis, adenoids, nasal polyps, diseases of the oral cavity. In this case, the symptoms of the disease are not detected immediately, but appear gradually, the body adapts to new conditions before the condition becomes more complicated. Therefore, laryngeal stenosis is often not detected immediately. Children with a clear picture of croup during subacute development feel satisfactorily when, during an acute course, the condition is severe.

False croup in children: symptoms and treatment

Symptoms of false croup and stages of development of the syndrome

The main sign that the likelihood of developing false croup in a respiratory disease is high is respiratory failure. The slightest signs of shortness of breath should alert parents, force them to be on alert, and take preventive measures.

Croup can occur suddenly, develop quickly, and in a short period of time go from a mild illness to a severe irreversible condition. But in most cases it does not reach the terminal stage; from the bright manifestations of the disease, the body returns to its original state just as quickly. But for this you need to know the symptoms and be able to help the child in time.

False croup occurs in 4 stages. If timely measures are taken, negative dynamics can be stopped at stages 1–3. Symptoms of the disease are shown in the table.

Stage I. Compensation

Breathing features: shortness of breath only during emotional or physical stress. It is expressed not so much by increased breathing, but by lengthening the inhalation, the disappearance of the pause between inhalation and exhalation.

Feeling satisfactory, symptoms of the underlying disease (fever, cough, runny nose, etc.)

Outcome: Recovery or transition to the second stage.

Stage II. Subcompensation

Features of breathing: shortness of breath, even at rest, rapid breathing. Inhalation is difficult and accompanied by wheezing. To ensure breathing, auxiliary muscles are activated - the muscles of the chest, abdomen, and when inhaling, the wings of the nose inflate. Cyanosis (blueness) of the nasolabial triangle. Rough barking cough.

The child is restless, touches the collar of his shirt, feels afraid, and cries.

Outcome: Reverse development of the syndrome or transition to the stage of decompensation.

Stage III. Decompensation

Features of breathing: suffocation, paradoxical breathing - superficial and infrequent, pallor of the skin.

The child is lethargic, apathetic, there is no activity, the consciousness is unstable, confused.

Important! Spontaneous resolution of the syndrome at this stage is rare; urgent assistance is required.

Stage IV. Terminal

Features of breathing: respiratory arrest and drop in cardiac activity.

Increased pallor, loss of consciousness, involuntary passage of urine and feces.

Outcome: Clinical death.

Treatment of false croup syndrome

At the first signs of shortness of breath, it is necessary to take measures to stop the attack and eliminate the conditions for its development. The patient's parents should:

Call an ambulance immediately - if you suspect croup, the child needs a medical examination and, based on the results, hospitalization or outpatient treatment;
Create a calm atmosphere around the patient - do not shout, do not even talk loudly, express confidence in your behavior that the situation is under control;
If the patient is frightened, take the child in your arms and do not leave him alone in the room - nervous tension causes a reflex contraction of the ligament muscles, which aggravates the situation;
Ensure an influx of cool, moist air - it is best to open a window, even in winter (wrap up the child first) - cool air reduces the volume of mucous membranes, and moisture dilutes the secretion;
You can carry out inhalation using a nebulizer - inhaling cold steam will improve the child’s condition;
If an inhaler is not available, the child is brought into a bathroom filled with steam (it cools in the air), where it is useful to perform distracting foot baths.

These simple but urgent measures should help stop the development of false croup and wait for the arrival of doctors.

Important! In most cases, doctors suggest hospitalization - you should not refuse it: only in a hospital setting is it possible to provide round-the-clock qualified monitoring of the development of the disease.

Prevention of false croup

False croup is a disease of young children. This condition can occur in one child more than once, as a relapse during one illness or during the next illness.

And in adults and children over 6 years of age, croup is extremely rare, as is the case in infants under one year of age. By primary school age, the danger of a severe development of events is very unlikely - the experience of overcoming various childhood illnesses takes its toll.

Since false croup in children occurs during infectious diseases, it is obvious that it is necessary to ensure that the child gets sick less. However, this does not mean that isolation is necessary to prevent infection. In children, whose immunity is rarely associated with infection, the body's reaction to accidental contact with a pathogen, even the most trivial one, may be excessive. And this is a direct road to the croup.

The most important thing is hardening the body. It is necessary to ensure that changes in ambient temperature, wind or draft do not become a problem or cause the introduction of infection. From the first days of life, children should breathe clean air, walk a lot every day, and be active. Warm and dry air irritates the respiratory tract more than frosty air. Adequate nutrition will ensure proper metabolism and age-appropriate development.

Contact with peers will teach the immune system to respond correctly to germs and viruses, most of which will not harm the child. These measures, of course, do not guarantee that the child will avoid croup, but it will be easier for the body (and parents) to cope with it.

Remember that only a doctor can make a correct diagnosis; do not self-medicate without consultation and diagnosis by a qualified doctor. Be healthy!