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Croup is one of the most common viral infections of infants and toddlers. It's not exclusively a disease of the very young, however, and doctors sometimes fail to diagnosis it with deadly consequences.

Lively seven-year-old Evelyn Smith, an article in Britain's Daily Mail newspaper tells us, died of croup after being turned away by three doctors in 36 hours.

On the evening of September 12, 2013, the little girl ran into her parents' room complaining she could not breathe. They took her to an emergency room, where at 4 the next morning a doctor finally gave her a shot of penicillin. Evelyn immediately threw up, but the doctor sent the family home. As soon as they got home, Evelyn's temperature began to soar, "never under 39.7C (103F)," the mother would later tell the inquest of her death.

A few hours later, the parents took Evelyn to a local medical center, where a nurse practitioner diagnosed the problem as inflamed tonsils, and wrote a prescription for more penicillin. She was better for a few hours, but her fever went even higher. Finally, the afternoon of the second day, the parents took Evelyn to clinic for a third time, whereupon a doctor diagnosed "oxygen saturations" and "moderate croup" (pronounced as if it were spelled croop). The doctor gave Evelyn an injection, wrote another prescription, and sent the family home yet again.

Evelyn collapsed and died at home two hours later. The doctors involved in the case were not found guilty of criminal neglect, but the judge noted "opportunities were missed."

Croup Isn't Just A Disease Of Babies And Toddlers

Evelyn's misfortune was to be treated by not just one but two doctors who worked under the misconception that croup is a disease only of the very young. While five to six of every 100 infants and toddlers catches this viral infection, it can also strike children, teens, and even adults. Just in the United States, about 1.5 million children a year are diagnosed with croup. 

Croup can usually be treated at home. Hospitalization is necessary in no more than 30 percent of cases. 

Even when a child has to be put in the hospital for croup, intubation for assisted breathing is necessary in only about 1 percent of cases. Steroids and adrenaline administered by nebulizers reduce the need to intubate. Among the victims of croup who receive hospital treatment, fewer than 0.01 percent die. Treatment with pencillin or other antibiotics, however, is ineffective because croup is a viral disease.

How Can You Know It's Croup?

Also known as laryngotracheitis and laryngotracheobronchitis, croup usually strikes the throat, not the lungs, although it can become a bronchial infection. It causes a tightness and narrowing of the throat that results in a very distinctive cough. The cough in croup sounds more like a bark, specifically more like a seal's bark, than a cough. When breathing is accompanied by stridor, a high-pitched musical sound (usually louder when breathing in, but also occurring during breathing out), emergency room treatment is a must.

Croup usually starts with the symptoms of a cold, including cough, runny nose, and sore throat. One or two days later there is a cough, with the possibility of respiratory distress. Usually the symptoms are worse between 10 p.m. and 4 a.m., and "spasmodic" croup can occur a week or two after the child (or sometimes teen or adult) appears to have recovered.

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