Winter months will bring questions about managing croup.
This swelling in the throat and windpipe usually affects kids 3 and under...causing a barking cough, hoarseness, or a "whistle" when inhaling.
Promptly refer if parents report these distinctive symptoms.
Don't suggest antibiotics...croup is almost always viral.
Explain corticosteroids help even mild croup...improving symptoms within a few hours and reducing ED visits and hospital admissions.
Point out the best evidence is with a single oral dose of dexamethasone, usually 0.6 mg/kg...up to 16 mg. Lean toward the 1 mg/mL concentrated solution for a lower volume than the 0.5 mg/5 mL liquid.
If you don't have the solution in stock or kids don't like the taste, suggest mixing crushed dexamethasone tabs in pudding or applesauce.
Or consider oral prednisolone (Orapred, etc) as an option...but it may need to be used for 3 days and has limited evidence for croup.
Advise giving fluids...and acetaminophen or ibuprofen for fever.
Use our patient handout, My Child Has Croup: What Can I Do?, to suggest other remedies...such as sitting in a steam-filled bathroom, using a cool-mist humidifier, or inhaling cold air from an open freezer.
Find more recommendations in our new chart, Management of Croup.
- Cochrane Database Syst Rev 2018;(8):CD001955
- Paediatr Child Health 2017;22(3):166-9
- J Pediatr Pharmacol Ther 2015;20(2):105-11
- Chart: Management of Croup
- Patient Education: My Child Has Croup: What Can I Do?