The health of the child due to age, is subjected to various tests, because his body is not yet very strong – the immune system is just beginning to form. And the respiratory system gets, first of all, under the risk of developing many inflammatory diseases, where factors that trigger diseases surround children everywhere. In this article, we will look at the symptoms and treatment of laryngitis in children.
What is laryngitis?
Laryngitis is one of the characteristic similar ills of childhood, which proceeds as a reaction of a weak body to many viral diseases. Inflammation of the larynx (laryngitis) is included in the program of many acute respiratory viral infections (influenza, parainfluenza, adenovirus infection). Often proceeds in combination with tracheitis (laryngotracheitis) or turns into tracheitis.
The younger the patient, the more dangerous the course of the disease. If in an adult it is accompanied only by temporary discomfort, then in children under 3 years of age there is a danger of the onset of croup syndrome – a narrowing of the lumen of the larynx. And in order not to bring the child’s state of health to the point of danger, at a minimum, it is necessary to know the first alarming symptoms, and to be able to act correctly in the event of an emergency.
The croup is true – it is ditpheria of the larynx (the larynx is clogged with diphtheria films). Most often the whole stenosis of the larynx in a child is FALSE croup. That is, swelling of the mucous membrane on the background of inflammation or an allergic component.
Inflammation of the larynx can occur as acute laryngitis, and as chronic. Larynx inflammation is classified according to the following forms:
- The catarrhal form belongs to the most innocuous type of laryngitis and is most common in children – it proceeds with symptoms typical of most infectious diseases of the respiratory tract: itching, sore throat, hoarseness, dry cough and low temperature, in some cases (in young children ) there is a development of respiratory failure and loss of voice due to severe swelling of the mucous.
- Hypertrophic form – this form is also often in children, in which there is hyperplasia and growth of the laryngeal mucosa.
- Hemorrhagic form – a characteristic feature of it is hemorrhage in the ligaments of the larynx and its mucosa. This form develops only in the presence of predisposing factors, such as the toxic form of influenza, various disorders of the hematopoietic system, diseases of the liver and cardiovascular system in a child. Distinctive features of the hemorrhagic form of laryngitis are dry mouth, dry paroxysmal cough, especially in the morning, sputum streaked with blood, feeling of a foreign body in the larynx.
- The diphtheria form is the laryngeal diphtheria (fibrinous laryngitis). That is the defeat of Lefleer’s wand with the defeat of the tonsils with white-gray raids, which extend to the lumen of the larynx and often clog it with true stenosis.
- Laryngotracheitis or podskladochny laryngitis – a form of the disease in which the initial sections of the trachea are involved in the inflammatory process. Dry coughing and scratching behind the sternum and throat is typical for her.
- Phlegmonous laryngitis is extremely rare, it develops on the background of reduced immunity, after injury or transfer of serious infectious diseases. At the same time, the muscular layer of the larynx, submucosa, perchondrium, ligaments are affected. Accompanied by phlegmonous laryngitis high fever, severe pain when swallowing, respiratory failure, adherence to the inflammatory process of the lymph nodes. Examination by a doctor – redness and inflammation of the mucous membrane with areas of necrosis.
- Atrophic form – as a rule, in children does not happen, with this form there is a thinning of the mucous membrane of the larynx.
Pediatricians revealed laryngitis incidence statistics – it is found in a third of children under two years of age, along with the usual acute respiratory infections. And, as a rule, this ailment most often occurs in conjunction with tracheitis and bronchitis. Especially high risk of laryngitis in children suffering from allergic reactions. When treating such babies, drugs should be carefully selected, do not use ointments with essential oils (not infrequently they increase laryngeal edema), use proven (non-allergic) medicinal plants, and medicines.
What contributes to the development of laryngitis?
Of course, it is clearly impossible to establish the true cause, since each child has individual characteristics. As a rule, several factors contribute to the provocative effect at once:
- Colds of various etiologies (ARVI, influenza, measles, adenoviruses, etc.).
- The reaction to inhaled substances, as a rule, are paints and varnishes (any varnishes, paints, new furniture, new household appliances from low-quality plastic), animal hair, dust. In practice, pediatricians most often encounter laryngitis in families that have recently moved to an apartment where repairs have been made or furniture has been replaced (a modern “gas chamber” for a person).
- Hypothermia, even the usual draft.
- Anatomical and physiological structure of the respiratory organs (narrow larynx and nasopharynx). Since any inflammation of the respiratory system causes swelling of the tissues, the larynx significantly narrows in the child, making it difficult for air to pass.
- The condition of the air, where the child is – for example, hot dry air, dust, irritation from exhaust gases, a smoky room.
- Mechanical factor – voice overstrain from singing, screaming, loud long-term conversation, damage to the larynx.
- When the stomach contents are thrown into the larynx, gastroesophageal reflux disease or aspiration of foreign bodies may cause laryngitis.
Children at risk of chronic diseases of the nasopharynx may be at risk, as a result, these patients have impaired nose breathing, and also have dental diseases of the oral cavity.
How to understand that a child has laryngitis?
The development of the inflammatory process in the larynx in children is more often manifested in the acute form and, as a rule, suddenly. Parents, in the first place, may notice in a child some changes in his voice, hoarseness, loss of appetite, due to pain when swallowing, dry cough, rapid or difficult breathing. At night and in the morning, the frequency of coughing increases, until the onset of attacks of suffocation.
Also, laryngitis can cause the following symptoms:
- the appearance of a cold;
- redness and swelling of the mucous membrane of the throat;
- the presence of bleeding in the area of inflammation;
- possible loss of voice, hoarseness;
- difficulty breathing due to spasm of the larynx, its edema
- feeling of sore throat, dry mouth;
- strong barking cough in a child, first dry, then gradually sparse sputum;
- a slight increase in body temperature, rarely high fever, headaches.
- see also causes dry cough without fever, or why dry cough does not go away or dry cough treatment in children and adults
Parents of the baby, that their child is sick, will be prompted by signs such as lethargy, anxiety, increased moodiness, the presence of nasal discharge and cough. And also a hoarse voice, which in laryngitis must be differentiated with hoarseness on the background of dehydration. With a progressive degree of laryngitis, screams are possible, accompanied by wheezing during breathing, listening to the lung area, noises and whistles are heard, the presence of cyanosis of the nasolabial triangle area is the distinguishing features of the progressive disease.
On examination, the doctor sees hyperemia of the oral mucosa, swelling of the throat and vocal cords (they are thickened, red, not fully closed). In chronic laryngitis, the main symptoms are itching, sore throat, a desire to constantly cough, a hoarse voice, or a change in timbre of the voice (due to swelling of the ligaments themselves, they thicken and oscillate with a different frequency – the sound is lower and acquires overtones due to uneven swelling and thickening is not the entire length of the uniform).
When should I call an ambulance?
- Disruption of normal breathing – it becomes intermittent, uneven, sometimes accompanied by shortness of breath. Even if such breathing doesn’t cause trouble to the baby, and it behaves as usual, there is a high probability of developing cardiovascular insufficiency or asphyxiation.
- Significant narrowing of the lumen of the larynx, as a result of its swelling, especially in young children. This phenomenon, called false croup, can lead to difficulty breathing, until it stops.
- Complicated forms of laryngitis, starting with the second degree, require mandatory treatment in the hospital.
- The presence in children of chronic diseases of the nervous system, allergic reactions and other factors that aggravate the child’s condition.
- In any case, if the baby has a fright when coughing, lack of air, the temperature stays above the norm for more than a day, you should immediately call an ambulance.
With the development of false croup, all efforts should be made to reduce spasm and edema of the larynx, restore normal breathing – alkaline inhalation should be carried out before the ambulance arrives, the child should be in an upright position in a humidified room, and distracting procedures can be done – hot foot baths. In the hospital, the baby will be given inhalations, oxygen therapy, according to the indications it is possible to carry out hormone therapy, and antihistamines and antispasmodics are indicated.
The narrowing of the lumen of the larynx goes through 4 stages, they are smoothed and take a short time:
- Stenosis of 1 degree – allows the child to breathe without shortness of breath, however, during exercise, the contraction of the upper sternum notch and the area above the navel already appears.
- Grade 2 – a restless child, agitated, turns pale, his nasolabial region turns blue, and a rapid heartbeat appears. The tissues experience oxygen starvation, the brain suffers. The entire chest and abdominal muscles are involved in breathing.
- Stage 3 – signs of respiratory failure, air intake occurs with noise, inhalation and exhalation is difficult, and sweating, cyanosis of the lips, fingers, and pallor are observed.
- Grade 4 is choking with shallow breathing, slow heartbeat, loss of consciousness.
How to properly treat laryngitis – general recommendations
Comprehensive treatment at the initial stages of the disease includes the following general recommendations for the organization of therapeutic measures:
- Requires strict bed rest.
- Limiting the load on the vocal apparatus – the child should speak less and be silent more. Of course, this is very difficult, but in turn, this measure is the key to quick recovery.
For children with laryngitis, the condition for limiting the vocal cords from overstrain is particularly important because they are at a stage of formation in childhood, and excessive exercise can lead to irreparable voice defects.
- Daily monitoring of air condition: the best option is sufficiently humid air, which can be provided with a humidifier and constant airing of the children’s room and the use of an air purifier after airing.
- Plentiful drink: compotes, herbal preparations, fruit drinks, milk, drinking water. The main condition – the liquid must be warm and not very sweet. The main goal is to prevent dry cough, moisturizing the mucous membrane of the oropharynx, reducing the body’s intoxication.
- Rational nutrition, balanced vitamins, while eliminating annoying foods. too hot or too cold, carbonated drinks. The food should be dietary, useful, try to surprise the child with the design of dishes to increase the appetite.
Drug treatment of laryngitis
Taking antihistamine drugs
This group of drugs is always prescribed for laryngitis, they will not only remove the swelling of the mucous membrane, but also have a calming effect on the baby, especially good if you take the remedy for the night:
- Fenistil in drops, Clarsens (even for babies)
- Zyrtec from 6 months
- Zodak – syrup from a year, tablets from 6 years
- Cetrin – syrup from the year, table with 6 years
- Claritin from 2 years
- Parlazin from 6 years
- Klarotadin from 2 years
- (see the list of all modern allergy pills and syrups for children).
Reception antitussive or expectorant
On the pharmaceutical market of such drugs a great many. But the choice should be made only by the attending pediatrician. In the case of a strong, paroxysmal cough, so that the child can fall asleep, the doctor may recommend antitussives or combination drugs in dosage, according to the age of the child:
When the cough becomes wet, the pediatrician may also recommend expectorants with a wet cough (list) – Althea, Alteyka, thermopsis, chest preparations – instructions, drugs with the active substance Bromhexin (Bronhossan, Solvin), Acetylcysteine (ACC, Fluimucil), ambo (Lasolvan, Ambrobene), etc.
Tablets for sucking, gargling
In our article gargling for sore throat, you can learn in detail about all the methods of gargling. As for the resorption tablets and aerosols, they cannot be used for laryngitis: against the background of dry cough and sore throat, the child can choke with tablets, and aerosols provoke laryngospasm. You should also carefully monitor the reaction of the baby, because any drug can cause laryngospasm, an allergic reaction, which aggravates the child’s condition.
Antipyretic or NSAIDs
At high temperatures in excess of 38 ° C, if the child suffers heavily, it is recommended antipyretic drugs for children (Panadol, Paracetamol, Efferalgan, Cifécon), non-steroidal anti-inflammatory drugs (Ibufen).
Physiotherapeutic procedures – local inhalation treatment
Warming compresses on the neck of the child are considered to be an excellent therapeutic effect, with laryngitis also shows dry heat on the neck, plenty of alkaline drinks, inhalations – both steam and medicinal using special nebulizer inhalers. Oddly enough, but the mustard plasters and banks are also very effective (if there is no high temperature), do not forget about the time-tested recipes of traditional medicine.
So, if there is no nebulizer, as an emergency aid, a simple steam inhalation is suitable for a child. How it can be done (see for more information about all the options for inhalation with laryngitis, bronchitis, pneumonia).
Inhalation is a complex effect on the respiratory system, not only with laryngitis. However, there are many nuances that should be followed when using steam inhalation, especially for children:
- Too small children should not be inhaled by steam because of the risk of mucosal burns.
- Inhalation can not be immediately after any physical stress of the child (he must be calm).
- They should be done 2 p / day between meals, the child can not talk either during or after the procedure for 30 minutes, nor drink or eat for half an hour after inhalation.
- During the procedure, you should inhale through the mouth, exhale through the nose.
How to do steam inhalation? You can simply hold the child in your arms in the kitchen near the boiling pot of water or sit on your knees and make a funnel on the kettle with hot water – breathe over the steam. The child must breathe as usual, evenly and not deeply. As for solutions for steam inhalations, they can be used only in the absence of allergy in a child to the components of these solutions:
- infusions of medicinal herbs – calendula, mint, mother and stepmother, pine buds, chamomile, sage.
- You can make inhalations by adding a few drops of 2-3 essential oils – juniper, tea tree, eucalyptus, cedar, thuja oil (with adenoids)
- salt solution – 3 tablespoons of sea salt + 3 tsp of baking soda per 1 liter, 5-6 drops of iodine.
When conducting a steam inhalation, parents should be very careful because:
- With a very hot, burning air, steam inhalations can significantly increase inflammation in the larynx, so you should strictly observe the optimum temperature.
- It is necessary to monitor the child so that he does not overturn a container with liquid or a kettle with boiling water.
Treatment of laryngitis in children with nebulizer inhalation
The most suitable means in children is inhalation with the use of nebulizers. The disadvantage of using compressor and ultrasonic inhalers is that it is impossible to use herbal decoctions and essential oils, but only mineral water and ready-made dosage forms of solutions for inhalation, except for some models (Dolphin F1000 is an inhaler in which with the help of a Rapidfla 2 sprayer RF2 You can use filtered decoctions and essential oils). Advantages of using nebulizers:
- possibility of use even in young patients;
- safety due to low temperature;
- high efficiency of increased dispersion of respirable particles;
- ease of use, because the procedure can be carried out even while the baby is sleeping.
As solutions for inhalation are used:
- soda solution
- mineral water (for example, Borjomi or Essentuki)
- decoctions of medicinal herbs (mint, chamomile, sage, thyme, and others), but only inhalers that allow the use of herbal decoctions
- essential oils (menthol, eucalyptus, oils of coniferous trees – spruce, fir), also essential oils can be used only in special inhalers
- garlic juice – natural phytoncide
- medicines – Lasolvan (Ambroxol), Rotokan, Sinupret, Tolzingon, etc. – according to the testimony of a pediatrician.
If the doctor has prescribed several drugs for inhalation, there is a rule:
- bronchodilator drugs are the first to go
- after 15 minutes expectorants
- After the child clears his throat, you can use anti-inflammatory and antiseptic agents.
In the hospital with laryngitis, according to indications, they can perform ultraviolet irradiation, electrophoresis on the larynx, UHF, microwave therapy, with persistent voice disorders, they conduct speech therapists and correct dysphonia.
Antibiotics for laryngitis: Pros and Cons
The use of antibacterial treatment in children with laryngitis is fully justified, with the following indications:
- the presence of a bacterial environment of inflammation, which is detected only after diagnosis – laboratory tests, taking a smear from the laryngeal mucosa;
- intoxication of the body – fever, weakness, chills, loss of appetite;
- Often, pediatricians reinsure themselves by prescribing antibiotics for uncomplicated laryngitis in order to avoid complications (see when antibiotics are shown for ARVI, colds in children).
Only in isolated cases are the causative agent of laryngitis bacteria, most often it is a viral infection that is not treated with antibiotics. That is, the appointment of antibiotics for laryngitis is mainly not considered necessary and effective measure of treatment.
Antibiotics, which are most often used in the treatment of laryngitis:
- Penicillin series (Amoxiclav, Flemoklav Solutab, Ekoklav suspension, Augmentin and others).
- Cephalosporins in the form of syrups (Cefix, Cefadox, Supraks), in the form of injections (Ceftriaxone, Fortum).
- In cases of severe laryngitis, macrolides, azithromycin – (Sumamed, Zetamax retard, Hemomycin, Azitrox, Ecomed), Macropen, Claritomycin are prescribed.
During the reception and after treatment, the above antibiotics are assigned probiotics, and for the normalization of the flora – Bifiform, Acipol, Bifidobacterin, Probifor, etc. (see the list of probiotics, Linex analogues).