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Croup

What is Croup? 

Croup is a condition which refers to the swelling around the vocal cords and other parts of the upper and middle airway that causes a harsh repetitive cough similar to a seal barking. This type of infection is typically caused by a group of viruses called human parainfluenza viruses. Less often, respiratory syncytial virus (RSV) or other respiratory viruses can cause croup. More cases of croup are typically seen in the fall.

Signs and symptoms

  • Sharp, barking cough (usually at night)
  • Labored or noisy breathing
  • Fever
  • Incubation Period
  • 2-7 days

Contagious period and spread

  • Parainfluenza viruses and other respiratory viruses are spread from person-to-person primarily by respiratory droplets created by coughing or sneezing. Transmission may also occur through contact with contaminated surfaces, hands, used tissues, or other articles soiled by nose and throat secretions.
  • The infection is passed for up to one week before onset of symptoms and 1-3 weeks after symptoms.

Public health reporting requirements

  • Report the infection to the facility director, school nurse, or child care health consultant. Discuss child health concerns with the school nurse or child care health consultant. Consultation with the state or local public health agency is also available.
  • If the child develops more severe symptoms or experiences ongoing symptoms, refer them to a health care provider to be checked for secondary complications (such as bronchitis, sinus infections, middle ear infections, and laryngitis).
  • If two or more children have symptoms of croup and/or received this diagnosis from a health care provider, this may be considered a suspect or confirmed outbreak and should be reported to state or local public health.
  • More information on reportability of respiratory illnesses in schools and child care are on CDPHE’s website under the link titled “Guidance for Prevention and Control of Viral Respiratory Illnesses in School and Childcare Settings.”

Control of spread

  • People who are ill should avoid direct and indirect exposure to others and stay home when sick.
  • Avoiding sharing cups and eating utensils and touching your face with unwashed hands. 
  • Disinfect eating and drinking utensils and commonly touched surfaces. (Disease Prevention: The Facility Environment)
  • Promptly dispose of tissues soiled with nose and throat secretions.
  • Teach children to cover their nose and mouth with a tissue when they cough or sneeze and promptly throw away the tissue after they use it.
  • Emphasize frequent and thorough handwashing, especially after coughing or sneezing.
  • Provide adequate ventilation to occupied spaces. Increase filtration of indoor air through HVAC and/or with HEPA portable air cleaners. 

Consult with local public health for assistance with implementation of control measures.

Treatment

There is no antibiotic treatment for a viral infection. Most infections require no treatment. Oral and nebulized steroids are sometimes used in severe cases.

Exclusion

Ensuring people who are ill stay home is critical to preventing the spread of croup and other respiratory illnesses. 

  • Students and staff with symptoms of respiratory illness should refer to the guidance and exclusion  criteria for respiratory illness symptoms and stay home until they are fever free for at least 24 hours without the use of fever-reducing medications (fever defined as a temperature of ≥100.4oF) and all other symptoms of respiratory illness, including cough, are resolved or improved for at least 24 hours.
  • Ill children and student should be supervised and separated from others until they can be picked up by a parent or guardian. 

Additional precautions are recommended for at least five days following the return of anyone recovering from respiratory symptoms, including increased hand and respiratory hygiene, improved ventilation, masking, physical distancing, and testing. 

Additional exclusion criteria are listed in previous section: Exclusion Guidelines for Children and Staff. 

Role of teachers, caregivers, and family

  • Practice good hand hygiene at all times.
  • Teach children to cover their nose and mouth with a tissue or upper arm sleeve when they cough and sneeze and  throw away the tissue after they use it.
  • Properly dispose of articles soiled with nose/throat discharges, such as tissues.

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