Croup in the Child Care Setting

What is croup?

Croup is a very common respiratory problem. It is a swelling of the airway at the voice box (larynx) and windpipe (trachea) usually caused by a virus. The same virus that causes croup can cause other respiratory diseases like bronchitis, bronchiolitis and pneumonia. Croup is characterized by a harsh barking cough that can be scary for children and caregivers.

Who gets it and when?

Croup is most common in children under 3 years of age. Some children get croup as often as they have a respiratory illness. It can occur at any time of the year, but is most common between October and March.

What are the symptoms?

When a child has croup, the airway just below the vocal cords becomes narrow. This makes breathing noisy and difficult. Usually a child with croup has a low fever. Because the voice box contains the vocal cords, the main symptom of croup is a harsh cough that sounds like a seal barking, following a runny nose, cough and hoarseness. Croup usually gets worse at night with a crowing sound while breathing. Croup may last one to seven days. Croup is usually managed by moisturizing the air.

How is it spread?

The germs which cause croup are spread from person to person by contact with respiratory secretions (sneezing, coughing, saliva). Croup is about as contagious as the common cold. Children with croup or other respiratory infections should not have frequent contacts with infants less than six months of age.

Should the child stay home?

There is no reason to exclude the child from child care simply because of their harsh cough. However, you can separate the child from other children in the program if (1) a specified cause is identified that requires exclusion, or (2) the child is not well enough to participate in usual activities, or (3) the illness results in a greater need for care than can be provided by the staff without compromising the health and safety of other children.

When should the child be sent home and seen by a health care provider?

A child who rapidly develops a crowing sound when breathing in and out (while at rest) needs to be seen by a health provider. This child may appear very sick, with a high fever, drooling, and a preference for sitting up. These symptoms are due to blocked air passages.