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Acute laryngitis (false croup) in children
Medical expert of the article
Last reviewed: 12.07.2025
Acute laryngitis in children (synonyms: croup, false croup, stenosis of the larynx, stenosing laryngitis, subglottic laryngitis, acute obstructive laryngitis) due to the small size of the larynx quickly spreads into the subglottic space, which is characterized by favorable conditions for the development of the inflammatory-edematous process due to the fact that in this area in children under 6-7 years old there is loose connective tissue, in which edematous-infiltrative processes develop, characteristic of subglottic laryngitis.
Acute laryngitis and laryngotracheitis are acute inflammation of the mucous membrane of the larynx and trachea.
Acute stenosing laryngitis is laryngitis with inflammatory edema of the mucous membrane and submucosal tissue of the subglottic region of the larynx, resulting in a narrowing of the lumen of the larynx or larynx and trachea.
This form of laryngeal disease is often accompanied by reflex spasms of the larynx, manifested by obstruction of the respiratory tract (laryngeal stenosis), very similar in its clinical picture to respiratory failure in diphtheria, hence the name of this condition - false croup. According to the French pediatric otolaryngologist Moulonge, approximately 85-90% of cases of respiratory failure in acute banal laryngitis in children are caused by subglottic laryngitis. V.E. Ostapkovich during the flu epidemic that raged in Russia in 1952, reported 80% of subglottic laryngitis that occurred in patients with influenza. Subglottic laryngitis most often occurs in children aged 2-3 years. According to the Romanian otolaryngologist N. Costinescu, in 21% of cases subglottic laryngitis was observed in infants, 52% in children aged 1-3 years, 18% in children aged 3-6 years, and 9% after 6 years.
Acute laryngitis (false croup) in children: ICD 10 code
- J04 Acute laryngitis and tracheitis.
- J04.0 Acute laryngitis.
- J04.4 Acute laryngotracheitis.
- J05.0 Acute obstructive laryngitis (croup).
[ Causes of acute laryngitis in children
The etiology of acute laryngitis is predominantly viral. The leading etiologic role is played by parainfluenza viruses, mainly type 1, followed by PC viruses, influenza viruses, mainly type B, adenoviruses. Less common are herpes simplex and measles viruses. Bacterial infection plays a lesser role in the etiology of acute laryngitis, but, as a rule, leads to a more severe course. The main causative agent is Haemophilus influenzae (type b), but it can also be staphylococcus, group A streptococcus, pneumococcus. In previous years, before mandatory vaccination of children against diphtheria, the main causative agent was the diphtheria bacillus, which has now become a rarity.
Subglottic laryngitis occurs almost exclusively in the cold season, in Russia more often between October and May, it often occurs as a complication of acute nasopharyngitis, adenoiditis, flu, measles, less often chickenpox, whooping cough, etc. According to statistics from the Iasi Otolaryngology Clinic (Romania), 64% of cases of subglottic laryngitis are due to flu and 6% to measles. Most often, subglottic laryngitis occurs in children suffering from exudative diathesis, spasmophilia, vitamin deficiency (rickets), and in artificially fed children.
The etiologic factors are the influenza virus, staphylococcus, streptococcus, and pneumococcus. According to V.E. Ostapkovich (1982), the influenza virus serves as a kind of protector, preparing the ground for the activation and proliferation of common microbiota by provoking capillaritis, exudation, and the formation of false films. The most severe forms of subglottic laryngitis are observed with the activation of staphylococcal infection, which most often causes pulmonary complications with high mortality (in the middle of the 20th century, the mortality rate for staphylococcal subglottic laryngitis complicated by pneumonia reached 50%).
Symptoms of acute laryngitis in children
Acute laryngitis usually develops on the 2nd-3rd day of acute upper respiratory tract infection and is characterized by hoarseness. Acute laryngitis is accompanied by a loud "barking" cough. In the lungs - conductive dry whistling rales, they are heard mainly on inhalation. The child is excited.
Acute stenosing laryngitis is characterized by a triad of symptoms - hoarseness, a ringing "barking" cough and noisy breathing - laryngeal stridor, which manifests itself mainly as inspiratory dyspnea. In addition, dry wheezing may be heard, mainly on inhalation. The child shows pronounced anxiety, is excited. The temperature reaction depends on the reactivity of the child's body and the causative agent of acute laryngitis. So, with parainfluenza etiology and RS-virus, the temperature reaction is moderate, with influenza etiology, the temperature is high. During the day, inspiratory dyspnea and the severity of airway obstruction vary from almost complete disappearance to pronounced, but are always maximally expressed at night.
The symptoms of subglottic laryngitis are typical in most cases and primarily affect children whose appearance before the crisis does not indicate the presence of any disease or whose medical history indicates that they currently have symptoms of rhinitis or adenoiditis. As noted above, subglottic laryngitis is characterized by an attack of false croup - a special form of acute subglottic laryngitis characterized by periodically occurring and more or less quickly passing symptoms of acute stenosis of the larynx;
It occurs mainly in children aged 2 to 7 years, which is characterized by a sudden onset; it occurs more often at night, as a rule, in previously healthy children or those suffering from acute respiratory infections. The onset of an attack at night is explained by the fact that in a horizontal position, swelling in the subglottic space increases and the conditions for expectorating mucus worsen. It is also known that at night, the tone of the parasympathetic nervous system (vagus nerve) increases, which leads to increased secretory activity of the mucous glands of the upper respiratory tract, including the larynx, trachea and bronchi.
In false croup, the child wakes up at night with signs of rapidly increasing suffocation, accompanied by severe respiratory distress, objectively manifested by signs of inspiratory dyspnea - retraction of the jugular and supraclavicular fossae, intercostal spaces during inhalation, cyanosis of the lips and nasolabial triangle, motor restlessness. V.G. Ermolaev described a respiratory symptom characteristic only of false croup, consisting in the fact that there is a time interval between exhalation and inhalation. It is characteristic that this symptom is not observed in true croup, in which the respiratory cycles follow each other continuously without intervals, and inhalation begins! Even earlier than exhalation, and the breathing itself is noisy, stridorous. During an attack of false croup, the sonority of the voice is preserved, which indicates the absence of damage to the vocal folds - a sign that is not characteristic of diphtheritic laryngitis. At the same time, a dry, hoarse, barking cough occurs.
Cough is a consequence of reflex excitation of the cough center and occurs as a reflection of the protective mechanism that prevents accumulation and promotes rejection and release of inflammation products (mucus, prolapsed epithelium, crusts, etc.) from the larynx and lower respiratory tract. There are two types of cough: productive (useful) and unproductive (not useful). Productive cough should not be suppressed if it is accompanied by secretion, inflammatory exudate, transudate and agents that have entered the respiratory tract from the external environment. In all other cases, it is called unproductive, and sometimes it causes additional irritation of the larynx.
The presence of a hoarse cough and ringing speech is almost a pathognomonic sign of subglottic laryngitis. The above phenomena can last from several minutes to 2-3 hours; the attack ends with the release of viscous sputum. The child wakes up in the morning in a normal state. The attack can recur the same night or the next; in some cases it does not recur. If it is possible to perform indirect laryngoscopy, then hyperemic, edematous ridges can be seen under the normal-looking vocal folds; during laryngospasm, the vocal folds are in a closed or almost closed state on exhalation, and slightly diverge on inhalation, while the width of the respiratory slit does not exceed 2 mm. A similar picture appears with direct laryngoscopy.
Temperature reaction during an attack is not expressed and dissociates with a rapid pulse. With two or three attacks per night, a large load on the myocardium occurs, which can lead to collapse.
Among the possible complications, the most severe are bronchopneumonia and laryngotracheobronchitis, in which the prognosis for life is very serious.
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Classification of acute laryngitis
Acute laryngitis is divided by etiology into viral and bacterial, by the stage of laryngeal stenosis - into compensated laryngitis, subcompensated, decompensated and terminal laryngitis. In addition, by the nature of the course, uncomplicated and complicated laryngitis are distinguished, as well as recurrent laryngitis and descending. The latter occurs with diphtheritic laryngitis, when the inflammatory process spreads to the mucous membrane of the trachea, bronchi and bronchioles.
Diagnosis of acute laryngitis in children
Diagnosis of the disease is based on clinical data, in case of stenosing laryngitis - on data from direct laryngoscopy.
In case of acute simple laryngitis, there is no need for laboratory testing.
In case of stenosing laryngitis, the acid-base balance of the blood is determined and a peripheral blood analysis is performed.
- The acid-base balance of the blood in stage I is without significant changes.
- In stage II, the partial pressure of oxygen in the blood is moderately reduced, the partial pressure of carbon dioxide is unchanged.
- In stage III, the partial pressure of oxygen is reduced, the pressure of carbon dioxide is increased, respiratory or mixed acidosis is noted. Oxygen saturation decreases.
- In stage IV, the terminal stage, pronounced acidosis is observed. Oxygen saturation is sharply reduced.
The diagnosis is established on the basis of the clinical signs described above and data from direct laryngoscopy. False croup is differentiated from reflex laryngospasm, which occurs in children aged 2-3 years, is more pronounced, but shorter, and is not accompanied by inflammatory phenomena, barking cough, but may be accompanied by general convulsions and signs of spasmophilia. Banal acute laryngitis, in contrast to false croup, is characterized by a certain temporary development of dysphonia. The main danger in the occurrence of laryngospasm is the omission of laryngeal diphtheria, therefore, in all cases of obstructive laryngitis, this infectious disease should be excluded. False croup differs from diphtheritic croup in that in the latter, stenosis increases gradually, just as signs of diphtheria gradually increase, reaching complete aphonia, and in the larynx, characteristic diphtheritic plaques are observed spreading to all its parts.
In differential diagnostics, it is also necessary to take into account the possibility of the presence in the child of a number of pathological conditions that can manifest as laryngeal spasm syndrome (congenital stridor, laryngeal malformations, laryngeal lesions in congenital syphilis, neurotoxicosis in severe nephropathy, macroglossia, tongue retraction, congenital laryngeal tumors, retropharyngeal abscess, laryngeal papillomatosis, mediastinal tumor, adenopathy, thymus hypertrophy, asthmatic syndrome, acute pneumopathy).
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Treatment of acute laryngitis in children
Therapy for acute laryngitis is aimed at preventing laryngeal stenosis and, if it occurs, at restoring laryngeal patency.
In acute laryngitis, it is necessary to explain to parents that it is necessary to create an environment that excludes negative emotions, since the baby's anxiety may be an additional factor that contributes to and intensifies laryngeal stenosis. It is necessary to provide the patient with access to fresh air in the room where he is located, and humidify the air in the room. It is useful to give the sick child warm alkaline drinks (milk with soda: 1/2 teaspoon of soda per 1 glass of milk, milk with Borjomi mineral water).
As a first aid, an attack of false croup can be attempted to be eliminated by alternative stimulation of other sensitive nerve elements. For example, G.L. Nazarova (1960) recommends pressing a spatula or a teaspoon on the root of the tongue; the resulting gag reflex usually relieves the spasm of the glottis. Sometimes it is enough to tickle something in the nose to cause a sneezing reflex.
Other methods include warming compresses on the larynx and chest, hot foot baths, mustard plasters on the chest and interscapular region and on the calf muscles, and cupping on the back. Some doctors recommend waking the child up for the next few nights and giving him or her sweetened drinks, alkaline mineral water or fruit juice to prevent repeated attacks. In the last century, ipecac and apomorphine were prescribed per os in expectorant doses, and for severe coughs in older children - codeine and libexin.
Antitussives are used for unproductive cough. They are divided into two groups: peripheral and central action drugs. For cough caused by laryngeal irritation (acute catarrhal laryngitis, subglottic laryngitis, false croup, etc.), drugs in the form of syrups and lozenges are used (for young children - in the form of special sucking sticks that have a softening effect). For cough caused by irritation of the trachea and lower respiratory tract, inhalations of aqueous medicinal aerosols and thermal procedures are used. Morphine-like compounds (codeine, pholcodine, noscapine, dextromethorphan, codelac, coldrin, etc.) and substances that differ in structure from opiates (libexin, tusuprex, etc.) are used as central action antitussives. At the same time, antihistamines (H1-receptor blockers with sedative and choliolytic properties) are prescribed, for example, diphenhydramine (diphenhydramine), which suppresses cough by inhibiting the excitability of the cough center and enhances the effect of other antitussive agents of peripheral action.
In case of laryngeal edema, along with antihistamines (diphenhydramine, diazolin, suprastin), glucocorticoids (dexamstazone, dexaven), as well as antispasmodic and sedatives (calcium chloride, calcium gluconate, phenobarbital, etc.) are prescribed. Older children are prescribed laryngeal sprays (5% cocaine hydrochloride solution diluted 1:200 mixed with 3% ephedrine hydrochloride solution), as well as instillations of 0.1% adrenaline solution. To prevent subglottic inflammation in the first days, antibiotics are prescribed in a mixture with hydrocortisone (500,000-1,000,000 IU penicillin + 150-200 mg cortisone daily).
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What is the prognosis for acute laryngitis in a child?
The prognosis for acute laryngitis and laryngotracheitis is favorable. For stenosing laryngitis, it is also favorable if treatment is started early. If treatment is started late, especially in the terminal stage, a fatal outcome is possible.