Croup

IBIS:

Definition:
Acute laryngotracheobronchitis; an acute inflammation of the upper and lower respiratory tracts, characterized by inspiratory stridor, subglottic swelling, and respiratory distress that is most pronounced on inspiration.

Etiology:
Parainfluenza viruses are the major pathogens; spread is most commonly airborne or by contact with infected secretions: Generally age group 6 mo. to 3 yrs..

Nutrition:
eating principles: • eat as little as possible. • increase Vitamin C foods • increase fluids • short fast

therapeutic foods: • garlic, onions, leeks, turnips, grapes, pineapple, honey, green leafy vegetables (Jensen, p. 61)

fresh juices: • carrot (Walker, p. 133) • carrot and spinach (Walker, p. 133) • carrot, beet, and cucumber (Walker, p. 133)

avoid: • cow's milk and other dairy products, white bread, refined foods, processed foods, sugar and sweets, catarrh-forming foods: oranges, tofu, tomatoes; meat, ice cream, shellfish, heavy protein foods, fats, meats, vinegars, shellfish

Botanicals
• Aconitum napellus (toxic): clears heat (Felter and Lloyd, p. 105) • Allium sativum • Cephaelis ipecacuanha (Ipecac): (Ellingwood, p. 245) • Echinacea angustifolia: purifies blood (Ellingwood, p. 360) • Eucalyptus globulus: membranous croup with Pilocarpus jaborandi (toxic) (Ellingwood, p. 177) • Lobelia inflata (toxic): anti-spasmodic, without depression (Ellingwood, pp. 237, 239) • Phytolacca americana (toxic) (Ellingwood, p. 375) • Sticta pulmonaria: with Trifolium pratense (Priest and Priest, p. 95) • Stillingia sylvatica (toxic): see formulae • Trifolium pratense: spasmodic croupy cough (Priest and Priest, p. 95)

Chinese Formulae
• Lapis 16 (Dharmananda) • Platycodon and Schizonepeta F. (Zhi Sou San): Wind-Cold. (Hsu, 1980, p. 546; Yeung, p. 293; Bensky and Barolet, p. 446)

Acupuncture
after assessing the person and palpating, consider these patterns: Lung Heat; Lung Qi and/or Yin Xu (Deficiency)

» illustrative combinations: • Lung Cold: if vein at san guan (radial side of index finger) red, needle GB-20, UB-13 and CV-6; tui na: reduce fei jing (rubbing vigorously up and down along the Lung channel on the forearm), spread CV-17, grasp GB-20, grasp GB-21, knead UB-13, push san guan (Ambrose) • Lung Heat: needle GB-20, UB-13, Lu-5; tui na: reduce fei jing, push CV-17 to CV-12 area, grasp GB-21, knead UB-12, knead UB-13, push lin fu - Lung channel forearm (Ambrose) • Lu-11 and/or PC-9: can bleed few drops to reduce high fever IF patient NOT demonstrating a Xu (Deficiency) condition • St-8, yin tang, and/or tai yang (-): relieve headache; expel Wind and Heat; resolve Dampness from the head; esp. useful with headache or feeling of heaviness in head due to Shi (Excess) Dampness • GB-20, GV-14 and UB-12 (-): expel Wind and clear Heat • St-12, CV-17, CV-14 for cough (Lee and Cheung, p. 242) • Lu-10, Lu-7, SI-1, St-12 for cough (Lee and Cheung, p. 242) • SI-1, UB-15, St-14 for cough (Lee and Cheung, p. 242) • UB-23 and UB-47/52 (+): increase vitality; tonify the Kidney; strengthen Kidney function of reception of Qi; Kidney Shu Associated point and Kidney psychospiritual associated point

Homeopathy
• Aceticum acidum: membraneous croup; lining membrane of larynx and trachea covered with fibrinous exudation; difficult breathing and hissing respiration; rattling from laryngeal obstruction, < at each inhalation; no thirst; child swallows with difficulty, even a teaspoonful of water, bright redness of face, < evenings with coldness, at night; heat, dry skin and delirium. • Aconitum napellus: from exposure to dry, cold northwest wind; child is aroused from sleep by long suffocative attacks; cough hard, dry, barking, but not yet wheezing nor sawing respiration; cough and loud breathing during expiration, but not during inspiration; every expiration ends with a coarse hacking cough; fear of choking to death; high fever; dry skin, anxiety and restlessness; child in agony and throws itself about, > from cold drinks and < after eating • Arsenicum album: larynx sensitive to pressure; hoarseness in daytime; dyspnea and suffocative spells at night, esp. after midnight; croup with coryza; cannot breathe through nose, with restlessness and thirst, but can only take sip and is always < after drinking; child feels cold and want to be covered; croup before or after hives or nettle-rash, great prostration • Belladonna: case characterized by single attacks, hollow cough, with strangulation and putting hand on larynx; fauces red and great sensitiveness of lower portion of larynx to the slightest pressure, < when coughing, talking or taking breath; painful dryness of larynx, great aversion to all drinks; hoarseness with flushed face and congested eyes • Bromium: hoarseness several days; in evening near aphonia, jumping up for want of breath while eating or drinking anything cold, > after warm, hot drinks; more difficult swallowing fluids than solids, < by warm air in the room; child wants to be carried; whistling breathing with danger of suffocation from too much phlegm; < before midnight, > after it; suits light-complexioned children, light hair, eyes • Hepar sulphur: cough < by dry cold wind, swelling below larynx; rattling, choking worst in the early hours of the morning; child chokes with coughing spell, has to sit up and bend the head back; > being kept warm, < drinking and eating, every little motion causes slight perspiration, or clammy, sour sweat; frequent desire to urinate, dark yellow and depositing a white sediment; cough comes as soon as child lies down at night and gets worse toward morning; sensation of fishbone in the throat, causing stitching pain from ear to ear when swallowing or turning around • Iodium: black-eyed dark-complexioned children; wheezing, sawing respiration, with dry, barking cough during which the child strangles so that he clutches his throat; tendency to torpor, difficult inspiration, > cold and after eating, constant desire to change position; coldness of face in very fleshy children • Ipecacuanha: catarrhal croup, convulsive evening cough; expectoration of mucus, with metallic taste; rigidity of body followed jerking of arms toward each other; nausea and vomiting < from least motion • Kali bichromicum: suitable for fat, light haired and plump children; gradual and insidious onset; expectoration of tough, stringy mucus, < on waking, at night with definite aggravation at 3 a.m.; deglutition painful, tonsil and larynx red swollen covered with false membrane, difficult to detach > breathing; head bent backward, breath offensive, death from asphyxia if not relieved; cough warm in bed; lach. follows well • Lachesis: children subject to inflammatory rheumatism, < after sleep, after short nap; when totally aroused breathes more freely, cannot bear anything touching the neck, < left side of throat; sensation of crumb of bread sticking in throat causing frequent hawking and swallowing • Phosphorus: hoarseness, with tendency to relapse in tall, slender nervous children, even aphonia after croup, > toward morning, a feeling of hunger demanding food for relief; pain in larynx when speaking, child says it hurts him to talk • Sambucus nigra: spasm of the glottis during sleep; attacks just after midnight, and from lying with head low; frequent waking from fear of suffocation; mouth and eyes half open, profuse perspiration only after waking, dread of being uncovered • Sanguinaria: pseudomembraneous croup; aphonia, with swelling of the throat; steady, severe cough without expectoration, with pain in the head and circumscribed redness of the cheek • Spongia tosta: children with fair complexion; no mucus rales with the croup; cough dry, sounds like a saw, driven through a pine board; fear of choking to death, < when lying down, before midnight, > from warm food and drink; croup does not extend below larynx

Subtle Support
• notes: A, A#, B, C, C#, D, D#, E, F, G, G#

• chords: dominant 7th, diminished 7th, diminished 8th, A Major, A# Major, C Major, G Major, G# Major (Gimbel, p. 116)

Mind/Body
• Inflamed family environment; arguments and yelling, sometimes silent. (Hay, 1984, p. 158)

Chinese psychophysiology: • Lung ~ Fei is the home of the Po (Corporeal Soul); governs the Qi; facilitates the immune function by assisting the dispersal of the Wei (Protective) Qi; regulates the rhythm of respiration, the pulse, and all bodily processes; relates to strength and sustainability; moves and adjusts fluid metabolism; includes the throat; and opens at the nose. » Healthy expressions are righteousness and courage. » Weakness, dysfunction, and illness are associated with excessive grief, sadness, worry, and depression. Worry depletes the Lung Qi. » Lung Shi (Excess) signs include panting; yawning; sneezing (Seem, p. 28); pain in the upper back, shoulder, and chest; colds with stuffed nose; hoarseness; wheezing respiration; frequent urination with small amounts; heavy chest; reduced lung capacity; coughing; and nasal discharge. » Lung Xu (Deficiency) signs include cold shoulder and back; changing complexion; inability to sleep (Seem, p. 28); shortness of breath; changes in urine color; rumbling in the bowels with loose bowel movements; pallor; malar flush; chills; sniffles; sneezing; light cough; and sensitivity to cold.

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; facilitates inspiration by grasping and pulling down the Qi of the breath; and displays the effects of aging, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

Integrative Therapies
Croup is usually part of a cold. It primarily occurs in children aged 6 months to 3 years, though it may occur earlier or later.

Croup is an inflammation of the respiratory system and causes stridor, or noisy breathing. Stridor is a high pitched sound, like the blowing of the wind, that usually occurs when the child is taking a breath. This happens because there is an obstruction in the airway between the nose and the lungs. As a result, breathing is difficult and the child becomes tired from the effort. The underside of the tongue can also become swollen. The cough sounds like the bark of a sea lion and is often worse at night.

In simple croup there may be no other symptoms, but the child will often have a runny nose and a hoarse voice or cry. Some children will also have a fever and seem generally unwell.

There are other diseases that have some of the same symptoms as croup but are more dangerous and need immediate attention. The following situations could be an emergency since the child could suffocate to death. If your child has the following symptoms, contact your doctor immediately:

1. The child's lips become blue (cyanotic), he or she is drooling, has a lot of difficulty breathing, has very shallow breathing, wants to sit up and not lie down, is unable to sleep, and has a stiff neck (cannot bend the neck forward). Other symptoms include a sore throat and a hoarseness in the voice. Do not try to open the child's mouth to look into the throat. The airway may become blocked and the child would not be able to breath.

2. A foreign object could be blocking the airway and the child could have difficulty breathing and swallowing. If you know or suspect that a foreign object has been swallowed, call your physician or go to an emergency room.

THE FOLLOWING SUPPLEMENTS ARE USED FOR CROUP AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE:

1. Beta-carotene – 15,000 Units times age up to 100,000 Units per day.

2. Zinc – 5 milligrams times age, up to 50 milligrams per day.

3. Vitamin C – 250 milligrams times age per day, taken in divided doses.

HERBS USED FOR CROUP:

1. Lobelia tincture, which is a liquid herbal extract – 5 to 10 drops, 2 times a day, given in 1/3 cup of warm water. For children under 1 year of age, only 5 drops are used.

2. Other herbs to be used are Echinacea, Grindelia, and Yerba Santa. In the form of a tincture 10 to 20 drops, 3 times a day mixed with water or juice is used. It can be given in addition to or with the Lobelia.

HOMEOPATHY:

From the following homeopathic medicines, the one that best matches the symptoms is choosen. This is given 3 times a day while symptoms persist. A dose consists of 3 pellets placed under the tongue. For babies and small children, the pellets can be dissolved in a little bit of water.

• Aconite 12C: For the first signs of a cold or croup, especially if the child is fearful, restless, and very thirsty.

• Hepar sulph 12C: For croup with a hoarse cough and if the child gets chilly easily.

• Spongia 12C: For a dry, barking cough with a high pitched sound when the child breaths in.

A PROPER DIET FOR CROUP WILL INCLUDE:

Removal of allergic foods. If a child has recurrent croup, an allergy to cow's milk or a baby for-mula could be suspect. Nursing is recommended for at least 6 months since it is the best source of nutrition for infants and protects against infections. If the child is on a formula, changing the for-mula may improve the condition.

Food allergies need to be considered in older children as well. Certain foods seem more likely to cause croup. Eliminating these foods from the diet is a good way to determine if one or several of them are responsible. The main problem foods are dairy products (including milk, cheese and ice cream), wheat, corn, and sugar.

After eliminating all of those foods from the diet, and the symptoms have gone away, one food at a time can be reintroduced to see if the symptoms reoccur. A new food would be introduced each week. If you need more information, refer to the program on food allergies.

ADDITIONAL MEASURES INCLUDE:

1. Cool Air – A walk in the cool night air often helps. On bad winter days, holding the child outside under a covered area, such as a covered porch area, is a good idea.

2. Mist – Sit with the child in the bathroom with the door closed while the shower is running. A cool humidifier can also be used.

3. Cold/Hot Collar – Place 1 washcloth in a basin of ice cold water and another washcloth in a basin with hot water. Apply the ice cold washcloth to the front of the neck for 1 minute, then the hot washcloth for 1 minute. Alternate a few times.