Child checking adult's heart with a stethoscope

Croup in the Child Care Setting

What is croup?
Croup is a respiratory illness that causes airway swelling at the voice box (larynx) and windpipe (trachea). Most cases of croup occur when the body reacts to a viral infection. Parainfluenza viruses are the most common cause of croup.  However, other viruses (for example, respiratory syncytial virus, measles, influenza, rhinoviruses, and enteroviruses) can also cause croup. A child with croup will usually have a harsh, barking cough that can be scary for the child, other children, families, and caregivers.

Who gets croup and when?
Croup is most often seen in young children under 3 years old. Children usually have a runny nose, sore throat, and/or a cough before developing croup. Croup can happen at any time of the year, but it is most common between October and March (cold/flu season).

What are the symptoms of croup?
The throat just below the vocal cords becomes narrow when a child has croup. This makes breathing noisy and difficult. Because the voice box contains the vocal cords, the main symptom of croup is a harsh cough that sounds like a seal barking. Croup commonly gets worse at night with a crowing sound while breathing. The illness may last one to seven days. Children with lung diseases, such as asthma, are at risk for more severe illness.

How does croup spread?
The viruses that can lead to croup can spread from person to person by contact with respiratory secretions and through the air.  Sneezing, coughing, breathing, singing, talking can all spread these germs.  While one child might develop croup after being infected with the virus, another child might only experience a mild cold.

Should a child with croup stay home?
Children with croup should stay home if they do not feel well enough to participate in activities or, if they require more care than staff can safely provide while caring for other children. Croup is usually managed at home by providing liquids and moist, cool air, especially at night.

When should a child with croup be sent home and seen by a health care provider?
A child who is having trouble breathing should be seen by a health care provider right away. If the child develops respiratory distress, labored and noisy breathing, sucking in of the skin above and below the ribs, and flaring of the nostrils, call Emergency Medical Services (9-1-1).

What can be done to limit the spread of viruses?

  • Follow proper hand hygiene practices, especially after wiping or blowing noses; before and after contact with any secretions; before preparing, serving, or eating food; and after diapering and toileting.
  • Routinely clean objects and surfaces. Disinfect objects and surfaces that are soiled with body fluids.
  • Provide ventilation indoors. Spend time outdoors, even in winter.
  • Avoid crowding children together, especially during naps. Space cots and nap mats three feet a part or in a head-to-toe pattern.
  • Teach children to cough and sneeze into their elbow.
  • Change clothing soiled with mucous.
  • Wipe noses using disposable tissues, throw the tissue into the wastebasket, and wash hands.


American Academy of Pediatrics (2022) Croup and Your Young Child at

Shope, T., and Hashikawa, A. (2023) Managing Infectious Diseases in Child Care and Schools, 6th Edition, American Academy of Pediatrics (AAP).

Nemours, KidsHealth (2021) Croup at


November 2022, UCSF California Childcare Health Program

This article was made possible with funding from the Heising Simons Foundation.