Spasmodic Croup

In this condition there is a mild grade of

catarrh of the lining mucous membrane of
the larynx, accompanied by marked spasm of
the laryngeal muscles. This spasm is an
outcome of the excessive reflex nervous
irritability common to young children and gives
rise to the characteristic features of the disease.
Epidemiology
Spasmodic croup may occur during the first
six months of life, but is most frequent from
this age up to the third year, when the
tendency gradually diminishes until after the
fifth year attacks are unusual. While it occurs in
both healthy and delicate subjects, some
children possess a peculiar susceptibility, in
which heredity seems to play a part. The
exciting causes are exposure to cold, dampness,
and high winds, overeating, and indigestion and
constipation.
Sign and Symptom
Suddenly or be preceded by hoarseness
or by the symptoms of nasal catarrh.
The precedent symptoms usually appear
about midday and gradually increase. As
evening approaches an occasional
hollow, barking, evidently painful cough
is noticed and the voice is very hoarse;
toward midnight the cough becomes
more brazen and more frequent and the
breathing difficult.
In very mild cases these disturbances are
not severe enough to wake the child, but
when the laryngeal spasm is marked,
respiration becomes very labored,
especially the inspiratory movement,
which is attended by a hissing sound and
by visible retraction of the soft parts
above and below the breast-bone.
If untreated such an attack slowly
disappears, and in the course of three or
more hours the child, exhausted, drops
to sleep.
Comparison of Viral Croup and Spasmodic Croup

Characteristic Viral croup Spasmodic croup
Age Six months to six years (most
common)
Six months to six years (most
common)
Prodrome Common Uncommon
Stridor, barking cough Common Common
Fever Common Uncommon
Wheezing Common Common
Duration Two to seven days Two to four hours
Family history No Yes
Predisposition to
asthma
Uncommon Common
Adapted with permission from DeSoto H. Epiglottitis and croup in airway obstruction in
children. Anesthesiol Clin North Am 1998;16:860.
Some authors have tried to differentiate spasmodic croup from viral croup, but often the distinction is not
possible. Classically, patients with spasmodic croup develop symptoms suddenly, without a clearly
identifiable viral prodrome. Histologic evaluation of the subglottic tissues in patients with spasmodic
croup shows noninflammatory edema.6 Although associated with the same viruses that cause croup,
spasmodic croup tends to recur and may represent an allergic reaction to viral antigens instead of a direct
infection.