Pseudocroup: contagious, attack, symptoms and treatment

Pseudocroup is a condition that occurs in young children, causing shortness of breath, audible inhalation and barking cough (seal cough). In most cases it is caused by inflammation of the mucous membrane of the larynx (laryngitis). Pseudocroup mainly occurs in children aged one to five years. The condition is self-limiting in nature. Pseudocroup is not very contagious.

  • What is pseudocroup?
  • How do you get pseudocroup?
  • What are the symptoms of pseudocroup?
  • Who gets pseudocroup and when?
  • Is pseudocroup contagious?
  • What can parents/guardians do themselves?
  • Self-care
  • Additional advice
  • What does the GP do?
  • Prognosis

 

Pseudocroep / Source: Frank Gaillard, Wikimedia Commons (CC BY-SA-3.0)

What is pseudocroup?

Pseudocroup (subglottic laryngitis) is a viral infection of the upper respiratory tract that manifests itself in young children. Characteristic are the sharp barking cough (seal cough) and the often screeching sound during breathing, called ‘inspiratory stridor’. The condition mainly occurs in children one to five years old. The name pseudocroup is taken from diphtheria, the ‘real’ croup. This is because of the similarity of the symptoms.

How do you get pseudocroup?

A cold virus is the culprit, affecting the mucous membranes of the throat, nose and ears, as well as those of the larger respiratory tract. Swelling of the inner wall of the larynx occurs, making breathing difficult and causing the characteristic barking cough.

What are the symptoms of pseudocroup?

The child has a cold and a typical barking cough. There is often also a slight increase. An attack of pseudocroup almost always proceeds in the same way. The child is not sick, but often only has a cold. About ten or eleven o’clock in the evening or at night it wakes up crying. The child is short of breath and has difficulty breathing. This can cause it to panic. It is often frightening for the parents as well. When inhaling, a screeching sound is heard (stridor). The child has a loud barking cough (seal cough) and is sometimes hoarse. The temperature is normal or there is a slight increase. An attack of pseudocroup will disappear within a few hours, after which the child can sleep peacefully again. An attack of pseudocroup can occur once, but it can also occur for several days in a row. The next night the symptoms are usually less severe. In a few cases there are attacks with longer intervals.

Who gets pseudocroup and when?

It is mainly young children who get pseudocroup and occasionally it occurs in a young schoolchild. The incidence in the ages 0-5 years is between 15 and 37 per 1,000 children per year.ยน It is more common in boys than in girls. It is more common in the fall.

Is pseudocroup contagious?

Pseudocroup is an inflammation of the mucous membrane of the larynx, which is often the result of a ‘normal’ viral respiratory infection. A cold virus is contagious to other children. Cold viruses spread quite easily through moisture droplets in the exhaled air that can be inhaled by others.

What can parents/guardians do themselves?

Self-care

If the child wakes up feeling short of breath, he or she may panic and start crying. This causes higher oxygen consumption, which can lead to even more shortness of breath. That is why it is important that the child is calmed down by the parents/guardians. Keep the child with you until he or she falls asleep again. Warm, moist air has little effect, research has shown. So you don’t have to sit in the bathroom or shower with the child to steam. What matters is that the parents radiate calmness and put the child at ease.

Additional advice

Some more advice:

  • The child can breathe better if he sits upright or his head is a little higher;
  • Take the child outside when the air is dry and cold.
  • Offer the child plenty to drink, preferably something cold; or an ice cream cone.
  • Avoid large meals because coughing can make the child vomit.
  • In case of fever, you should ensure that the child is not too warm or is completely covered with a warm duvet.
  • Ventilate the room where the child is lying.
  • Do not expose the child to passive smoking. Tobacco smoke irritates the respiratory tract and increases the frequency of infections.

 

GP examines child / Source: Istock.com/michaeljung

What does the GP do?

If the child continues to have shortness of breath, it is wise to consult the doctor. The GP will examine the child and check whether there is indeed an attack of pseudocroup. The GP will listen to the breathing sounds with his stethoscope, among other things. In moderately serious cases, rest and a wait-and-see policy will almost always suffice. Antibiotics do not help with a virus and bronchodilators are only effective for narrowing of the small airways, such as in asthma, but not of the large airways. Cough syrups and other home, garden and kitchen remedies have no effect on the attack. In more serious cases of pseudocroup with severe shortness of breath, an (inhaled) corticosteroid (for example dexamethasone) can be prescribed. In rare cases, this condition has a serious course and a child must be urgently admitted to hospital. Sometimes intubation requires the insertion of a breathing tube. Alarm symptoms are the child becoming blue, pale or limp.

Prognosis

After the age of 4-5 years, the symptoms become milder. As a rule, pseudocroup is a mild disease that lasts 3-4 days; however, the coughing may last longer. Pseudocroup often gets worse at night when the child is in bed and gets better during the day.
Note

  1. Dr. JAH Eekhof, Dr. A. Knuistingh Neven, Dr. W. Opstelten: Minor ailments in children. Elsevier Healthcare, Maarssen, second edition 2009.

 

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