Croup—Child Care and Schools

What is croup?

Croup is a respiratory illness that primarily affects infants and children between 3 months and 5 years of age. Croup is caused by multiple different viruses and is characterized by a hoarse voice and distinct barky cough. Symptoms are a result of inflammation of the larynx (voice box) and trachea (windpipe). Parainfluenza viruses are the most common cause of croup; however, many other viruses (eg, respiratory syncytial virus, measles, influenza, rhinoviruses, COVID-19, and enteroviruses) can cause croup.

What are the signs or symptoms?

• Barky cough (like a seal).

• Hoarse or whispery voice.

• High-pitched, noisy breathing on inspiration (breathing in) called stridor .

• Runny nose.

• Fever may be present.

• Occasionally, children with croup may develop respiratory distress, which can be a medical emergency. This distress may include labored and noisy breathing, skin pulling in above and between the ribs, flaring nostrils, exaggerated abdominal movement during breathing, and anxiousness. Children with these symptoms require urgent medical attention, need to be treated in the emergency department, and sometimes may need to be hospitalized.

What are the incubation and contagious periods?

• Incubation period: 2 to 6 days for most parainfluenza viruses but may vary for other viruses.

• Contagious period: As with most respiratory viruses, viruses that cause croup can be spread for 1 week or longer.

How is it spread?

• Respiratory (droplet) route: Contact with large droplets that form when a child talks, coughs, sneezes, or sings. These droplets can land on or be rubbed into the eyes, nose, or mouth. The droplets do not stay in the air; they usually travel no more than 3 feet and fall onto the ground.

• Contact with respiratory secretions or contaminated objects from children who carry respiratory viruses.

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

• Prevent contact with respiratory secretions. Teach children and educators to cough or sneeze into a disposable tissue or their inner elbow/upper sleeve and to avoid covering the nose or mouth with bare hands. After coughing or sneezing, practice hand hygiene to prevent the spread of respiratory droplets. Ensure that anyone who contacts mucus or debris on their skin or surfaces washes their hands and any other contaminated skin immediately. Change or cover clothing soiled with mucus. Dispose of facial tissues that contain nasal secretions after each use.

• Ensure immunizations are up to date for all children. This may reduce croup caused by measles or influenza.

What are the roles of the educator and the family?

• Observe the child for signs of respiratory distress such as labored and noisy breathing, sucking in of the skin above and between the ribs, flaring of the nostrils, exaggerated motion of the abdomen with breathing, and anxiousness. Try to keep the child calm, as being upset and crying can worsen the cough and work of breathing. Cold, moist air can decrease swelling and noisy breathing; if it is cold outside, dress the child warmly and go outdoors. If these symptoms persist longer than 10 minutes, call emergency medical services (EMS) by dialing 911.

• Report the infection to the staff member designated by the early childhood education program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms of respiratory virus infection. The viruses that can cause croup may cause other respiratory symptoms.

• Practice control measures at home and educational settings.

Exclude from educational setting?

No, unless

• The child exhibits respiratory distress as described previously. (Call EMS [911].)

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ).

Readmit to educational setting?

Yes, when all the following criteria are met:

When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group