Croup—Child Care and Schools

What are the signs and symptoms?

• Barky cough (like a seal).

• Hoarse or whispery voice.

• 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, sucking in of the skin above and between the ribs, flaring of the nostrils, exaggerated motion of the abdomen with breathing, and anxiousness. Children with these symptoms require urgent medical attention, need to be treated in the emergency department, and 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, or sneezes. 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 the respiratory secretions from or objects contaminated by children who carry respiratory viruses.

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2.

• Prevent contact with respiratory secretions. Teach children and teachers/caregivers to cover their noses and mouths when sneezing or coughing with a disposable facial tissue, if possible, or with an upper sleeve or elbow if no facial tissue is available in time. Teach everyone to remove any mucus or debris on skin or other surfaces and perform hand hygiene right after using facial tissues or having contact with mucus to prevent the spread of disease by contaminated hands. Change or cover clothing with mucus on it.

• 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 teacher/caregiver 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. If these symptoms persist longer than 10 minutes, call EMS (911).

• Report the infection to the staff member designated by the child care program or school for decision-making and action related to care of ill children. 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 group care settings.

Exclude from group setting?

No, unless

• 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).

Readmit to group setting?

Yes, when all the following criteria have been 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

Comment

A child who develops high-pitched breath sounds (stridor) caused by a narrowed airway or respiratory distress may be treated with steroids. As long as the symptoms of stridor or respiratory distress have resolved, the child may return to care.