Acute Laryngotracheobronchitis (Croup) in Uganda: Causes, Symptoms, Treatment, Management, and Prevention

Croup is an infection that inflames the larynx, trachea, and bronchi, mostly in children under 3 years old. It is usually caused by a virus and leads to a distinctive barking cough, hoarse voice, and sometimes difficulty breathing. While most cases are mild, severe croup can be life-threatening and requires urgent medical attention.

If your child develops signs of croup, Hope Plus can connect you to a licensed healthcare provider within minutes. Providers can assess the severity, guide home care for mild cases, or advise urgent hospital care if needed. You can access this service here: Hope Plus.

Key Takeaways

• Croup is usually viral and mostly affects young children under 3 years.
• Early signs include a barking cough and hoarse voice.
• Severe croup can cause breathing difficulty, stridor (high-pitched breathing noise), and bluish skin.
• Most cases improve with supportive care; steroids may be used in moderate to severe cases.
• Avoid throat examination and cough syrups in young children to prevent worsening symptoms.

Causes of Croup

• Viruses are the most common cause, including:
  • Measles virus
  • Influenza virus
  • Parainfluenza type 1 virus
• Secondary bacterial infections are rare but can occur, in which case treatment is similar to severe epiglottitis.

Symptoms to Watch For

Early Phase (Mild Croup)

• Barking cough
• Hoarse voice or cry
• Stridor (high-pitched noise when inhaling)
• Cold-like symptoms

Late Phase (Severe Croup)

• Severe difficulty breathing (dyspnoea)
• Stridor at rest
• Cyanosis (blue lips or extremities)
• Risk of suffocation (asphyxia)

How Healthcare Providers Diagnose Croup

Diagnosis is mainly based on the child’s symptoms and physical examination. Providers avoid throat inspection, as this may trigger airway obstruction in severe cases.

Managing Croup

Mild Croup

• Isolate the child to prevent spread
• Ensure rest and hydration (oral fluids or ORS)
• Pain relief with paracetamol
• Single-dose steroids to reduce inflammation:
  • Prednisolone 1–2 mg/kg orally
  • Or dexamethasone 0.15 mg/kg orally

Severe Croup

• Hospital admission for close supervision
• Provide humidified oxygen (30–40%)
• IV fluids for hydration (Darrow’s solution ½ strength in 2.5% glucose)
• Steroids:
  • Hydrocortisone IV/IM:
    • Child <1 year: 25 mg
    • 1–5 years: 50 mg
    • 6–12 years: 100 mg
  • Or dexamethasone 0.3 mg/kg IM, repeat after 6 hours if necessary
• Nebulised adrenaline (0.4 mg/kg, max 5 mg) diluted with saline, repeat after 30 minutes if required
• Severe respiratory distress may require nasotracheal intubation or tracheostomy and ICU or HDU admission

Important: Avoid cough mixtures in children under 6 years.

Prevention

• Avoid contact with infected persons
• Isolate children who are sick to prevent the spread of the virus

FAQ: Common Questions About Croup

1. What causes croup?
Most cases are caused by viruses, including parainfluenza, influenza, and measles viruses.

2. How can I tell if croup is severe?
Severe croup includes difficulty breathing, stridor at rest, and bluish skin. These children need urgent hospital care.

3. Can croup be treated at home?
Mild cases can be managed at home with rest, fluids, and a single dose of steroids under medical guidance.

4. Should I examine my child’s throat?
No. Throat inspection can worsen airway obstruction in severe cases.

5. When should I seek medical help?
If your child struggles to breathe, has persistent stridor, or shows blue lips or extremities, go to the hospital immediately.

6. Are antibiotics needed for croup?
No, antibiotics are rarely needed unless there is a bacterial superinfection.

7. Can croup be prevented?
Good hygiene and isolating infected children can reduce spread. Vaccination against measles also helps prevent viral croup.