Causes and Treatments of Croup (Barking Cough)

What is a barking cough?

The medical term for a barking cough is croup. It is a medical condition that tends to irritate a child's upper airways. It can also be used to describe the inflammation of the larynx and trachea in children. There are a variety of reasons or inflammatory conditions, which can lead to the occurrence of a barking cough. These conditions are often characterized by their varying degrees of inspiratory stridor, which is also termed as airway obstruction, hoarseness, and a barking cough due to the obstruction it causes to the area of the larynx.

Below are the organs, tissues, and structures that are included in the upper respiratory tract:

• Larynx - It is known as the "voice box", which has the vocal cords.

• Pharynx - It is located at top of the throat, wherein the openings of the mouth and nose are known to meet.

• Epiglottis - It is a flap of tissue in the throat that tends to prevent or obstruct food and liquids from entering the windpipe.

• Trachea - It is also known as the windpipe, which leads to the bronchi.

• Bronchi - They are the tubes that branch off the trachea and also lead into the lungs.

When it comes to croup, its main characteristics are swelling and inflammation around the windpipe and vocal cords.  Most of the time, the children who suffer from croup tend to recover within a few days. However, in severe cases of croup, hospitalization may be required.

Causes

Croup is seen as a common respiratory condition in children. It can be caused by any type of allergic reaction as well as viral infections. A child who suffers from croup would have a cough that sounds like a seal barking along with making a rasping noise, which is known as stridor as they breathe in.

Around 3 percent of children are said to be affected by this medical condition every year, especially during winter and autumn seasons. Children who are 3-6 years old are more susceptible to getting the condition. However, older children can also get affected.

Croup Due to Viral Infections

The human parainfluenza viruses types 1, 2, and 3 tend to account for almost 70-80 percent of croup cases. The HPIV-1 or the human parainfluenza virus type 1 is said to be the most common cause of croup. Around 66 percent of croup cases are caused by the human parainfluenza viruses types 1 and 2. Type 4 has two subtypes: 4A and 4B. They are known to be associated with milder forms of illnesses, but are still not well-understood.

According to research studies, other cases of croup may be caused by the following harmful microorganisms:

• Respiratory syncytial virus (RSV)
• Influenza A and B 
• Coronavirus
• Adenovirus
• Metapneumovirus
• Mycoplasma 

A viral infection that tends to escalate into this medical condition would also typically take the following course:

• The virus would start to infect the throat and nose.
• The virus spreads along the respiratory tract, which is at the back of the throat to the trachea and the larynx.
• As the infection tends to progress, there would be swelling on the top portion of the trachea.
• The space available for the air to freely enter into the lungs would start to get narrow as the infection progresses.
• Due to the narrowing of the space, the child would tend to breathe rather quickly and deeply, which then leads to the symptoms of croup.
• Children suffering from croup would start to feel restless or get easily agitated since they would find it difficult to breathe. The agitation would also lead to the constriction or narrowing of the throat, which in turn, leads to an increase in breathing difficulties. The child would also find it tiring to breathe faster and harder in severe cases.

Bacterial Infection

Apart from viral infections, a barking cough can also be due to a bacterial infection. Bacterial and viral infections usually affect the same respiratory regions. However, in this case, it is a bit more severe. Moreover, the mode of treatment would also be different.

It has been seen that most cases of croup are caused by a secondary form of bacterial infection due to Staphylococcus aureus and other types of bacteria which would include:

• Streptococcus pneumoniae
• Moraxella catarrhalis
• Streptococcus pyogenes
• Haemophilus influenzae

Treatment

When it comes to the treatment of a barking cough, antibiotics may not be beneficial since most cases of this condition are due to viral infections instead of a bacterial infection. The conventional mode of treatment would involve over-the-counter medications for colds and cough.

In certain cases, the doctor may also prescribe steroids such as prednisone, dexamethasone, and prednisolone. These medications are often suggested to the patient to reduce swelling and inflammation of the airways. 

If croup becomes severe, then the child is immediately put on a breathing treatment, which contains a medicine called as epinephrine. This medicine is known to quickly reduce airway swelling. Over-the-counter medications, epinephrine, and steroids are all known to reduce the symptoms very quickly. However, one should not forget that they are accompanied by their own list of side effects, which can be harmful as well.

In severe cases of croup, hospitalization would be required. But how will you know if your child needs to be taken to the hospital? If your child finds it difficult to breathe, then it is important to seek immediate medical help since breathing difficulties can lead to certain complications. However, most cases of croup are usually mild in form and can be best managed using home remedies.

On an average, about 5-6 percent of children with croup need to be hospitalized. As per the randomized controlled trials or RCTs, it has been found out that in comparison with placebo, just one dose of oral dexamethasone given to children with mild croup can decrease the outcome in the coming 8-10 days.

Steroids medications are in no way capable of reducing the length of the infection. However, they are known to contain anti-inflammatory activities that can help reduce the severity of breathing difficulties. Prednisolone can also be used as an alternative instead of dexamethasone in certain cases.

Natural Remedies for a Barking Cough

It has been seen that almost 90 percent of croup cases can be successfully treated at home without the need for any medical intervention. Most of the time, croup in children would go away on its own. Moreover, according to research, it has been shown that croup and any other viral infections do not respond to antibiotics. The following are natural remedies for croup that you can try at home:

Steaming

Anyone who has an upper respiratory infection or breathing issues needs to breathe in moist air. To get immediate relief, one can go into the bathroom, shut the door, and turn on the shower to its highest heat setting. But remember not to go to the shower room or let the child into the shower room. Instead, it is better to sit outside the shower while it runs inside and try to breathe in the warm steam for around 10 minutes.

You can also use a cool mist humidifier in the bedroom during nighttime to put a continuous stream of warm mist into the air. It can help reduce the frequency of coughing, thereby making it easier for the individual to easily breathe. A spasmodic barking cough may significantly improve with the help of a cool mist vaporizer.

Increased Intake of Fluids

One of the recommended treatments for croup is to drink lots of fluids. It is mostly recommended by both the holistic health practitioners as well as doctors who take the conventional method.

Similar to the common cold, it is very important to keep oneself hydrated. Water has always been the number one option when it comes to increasing fluid intake. When it comes to small babies or infants, breastmilk is enough. For the older children, they can take soups, coconut water, homemade fruit juices, or broths.

By keeping oneself hydrated, any fluid loss due to fever can be replenished. It would also be easier for the body to fight off against any type of infection. Other warm liquids that can be consumed are herbal teas, soups, or broths. They are excellent when it comes to helping the vocal chords relax as well as loosen any sticky mucus. At the same time, it becomes quite important to avoid food items that can lead to an increase in the production of mucus. They include dairy foods, highly processed food items, and foods high in sugar.

Create a Soothing Environment

As a parent, it is very important to remain calm when your child has a barking cough so you can provide comfort. The sound of a barking cough can be quite intense, but don't panic. It is important that you stay calm so your child's breathing also becomes calm. Any kind of stress or tension can worsen your child's barking cough. You can keep your child busy with fun books or games as an encouragement to increase the pace of healing.

Rest

For those suffering from a barking cough, it is essential to take an ample amount of rest. But the one suffering from croup would find it difficult to rest in a flat position. It would make breathing easier as well as reduce the coughing if the patient is propped up well with the help of pillows. In the case of older children, you can raise the head of the bed to help the natural mucus to drain and help your child to easily breathe.