pediatrics
Croup
Symptoms and Signs of Croup
Croup is usually preceded by upper respiratory infection symptoms. A barking, often spasmodic, cough and hoarseness then occur, commonly at night; Stridor may be present as well. The child may awaken at night with respiratory distress, tachypnea, and retractions. In severe cases, cyanosis with increasingly shallow respirations may develop as the child tires. The obvious respiratory distress and harsh inspiratory stridor are the most dramatic physical findings. Auscultation reveals prolonged inspiration and stridor. Crackles also may be present, indicating lower airway involvement. Breath sounds may be diminished with atelectasis. Fever is present in about half of children. The child’s condition may seem to improve in the morning but worsen again at night. Recurrent episodes are often called spasmodic croup. Allergy or airway reactivity may play a role in spasmodic croup, but the clinical manifestations cannot be differentiated from those of viral croup. Also, spasmodic croup usually is initiated by a viral infection; however, fever is typically absent. 