Introduction

A young child presents with a deep barking cough. There could be a number of causes. Two key conditions which are important to be aware of are croup and tracheitis. These two are relatively common yet present similarly. This article will outline key differences and allow us to distinguish between the two conditions more easily.

Croup

Croup is the more common name for laryngotracheobronchitis. This is a respiratory infection of the upper part of the airway, commonly caused by viruses in young children. It causes swelling in the windpipe and causes ‘barking’ cough, hoarse voice and difficulty breathing. It will affect 15% of children at some point in their lifetime.¹

Tracheitis

Tracheitis is a condition also causing inflammation of the windpipe. It is more commonly caused by bacteria. It causes ‘barking’ cough, difficulty breathing and flu-like symptoms in children. In severe cases it can cause airway obstruction, and a child can stop breathing completely. 

Importance of Understanding the Differences

Clearly, croup and tracheitis present with very similar symptoms in children. It’s therefore possible to confuse the two and misdiagnose a patient.

The treatment of both conditions are however very different. Therefore, misdiagnosis could lead to incorrect treatment of the condition and as such the child’s condition may not actually improve. 

To understand the key differences between these two conditions we will first take a closer look at each condition in turn. 

Croup

Definition and Causes

Croup is an infection which causes swelling of a child’s airways. It is very contagious so is common amongst toddlers who interact with a lot of other children for the first time. It usually causes very mild symptoms but can be life-threatening in some cases. The most common age group affected is between 6 months – 3 years old.²

Croup is classically caused by a virus. Parainfluenza virus is by far the most common cause and accounts for 75% of cases.³ Other viral causes are influenza virus, measles, adenovirus, and respiratory syncytial virus (RSV). Rarely, it can be caused by bacteria, such as Corynebacterium diphtheriae causing the condition better known as diphtheria.

Clinical Presentation

Symptoms include a characteristic ‘barking’ cough. Other symptoms include stridor (a high pitched sound when the child breathes in), hoarseness of voice and difficulty breathing. The child will also be more agitated than usual and crying. Finally, a child may also have fever and runny nose. 

Diagnosis and Treatment

Croup is diagnosed based on symptoms. The severity of symptoms will determine whether the child can be managed safely at home or whether they will need admission to a hospital. Further tests such as X-rays and blood tests are often discouraged to prevent the child from having several unnecessary tests. 

The main treatment of croup is rest and keeping the child well hydrated. Steroids are sometimes given in more severe cases. Adrenaline is also sometimes given through a facemask which has been shown to reduce the severity of symptoms. Since croup is almost always caused by a virus, there is no indication for antibiotics. 

Prognosis of the condition is excellent and it is usually self-limiting. In very rare cases, a child can develop respiratory failure. 

Tracheitis

Definition and Causes

Tracheitis is an infection which causes swelling of the trachea. This affects children aged between 6 months – 5 years typically. It is a rare condition but can be life-threatening if untreated. It is more common in the Autumn and Winter months. 

Tracheitis is most commonly caused by bacteria. The most common cause is staphylococcus aureus. Children who have a weakened immune system (or ‘immunocompromised) are particularly at risk of this condition. 

Clinical Presentation

The condition often presents initially like any other viral respiratory infection. Symptoms include a characteristic ‘barking’ cough. Other symptoms include stridor, fever, drooling of saliva and producing thick sputum. 

Diagnosis and Treatment

Bacterial tracheitis can be diagnosed by inspecting the trachea and observing evidence of inflammation and collections of sputum. 

Children with a diagnosis of bacterial tracheitis will require admission into the hospital. Treatment includes supplemental oxygen and intravenous antibiotics for severe cases of the condition. If children’s airways are at risk of blocking completely, a tube will be inserted to help them breathe. 

Key Differences: Croup v Tracheitis

Although so far it appears the two conditions present very similarly and could be easily confused, there are some key differences to distinguish them apart. 

Causes 

The underlying cause of the infections between the two conditions is typically different. Croup is mainly caused by viral infections – commonly parainfluenza virus. Tracheitis is classically caused by bacterial infection – commonly staphylococcus aureus. 

Incidence 

Croup is a very common condition amongst toddlers. It affects 15% of children at some point in their childhood. Tracheitis is actually very rare – with an estimated incidence of 1 in 1,000,000 in the UK.⁴

Age affected

As previously discussed, croup affects toddlers – primarily between the ages of 6 months – 3 years. Tracheitis affects children of all ages – primarily from 6 months to 14 years. Although there is overlap between these age groups, tracheitis should be suspected if an older child presents with suspicious symptoms. 

Clinical Presentation

Patients with tracheitis tend to be a lot more unwell than croup. Although both conditions present with fever, children with tracheitis will have a much higher temperature of greater than 39.0 degrees Celsius. 

The speed of onset of tracheitis is much faster than croup. Children will become unwell very quickly from onset of symptoms. Croup on the other hand progresses slower and children may not become as unwell. 

Response to Treatment 

Adrenaline is often administered to children with suspected croup. Given via a facemask, children usually have an excellent response. However, if given to a patient with tracheitis there will be little to no response. A lack of response to adrenaline would make a doctor suspect an alternative diagnosis to croup. 

Summary

Croup and tracheitis are two conditions affecting children which present very similarly. We have discussed key differences between the two conditions. If you suspect a child has either croup or tracheitis, please seek medical attention.