From the Guidelines
The treatment of pediatric laryngitis should primarily focus on supportive care and symptom management, avoiding the misuse of antibiotics unless a bacterial infection is confirmed, as most cases are caused by acute viral laryngitis. The mainstay of treatment for pediatric laryngitis includes home remedies such as adequate hydration, humidification of air using a cool-mist humidifier, and rest to reduce vocal cord irritation [ 1 ]. For pain and fever relief, acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) can be administered [ 1 ]. In cases of moderate to severe symptoms causing respiratory distress, a single dose of dexamethasone (0.6 mg/kg, maximum 10 mg) orally or intramuscularly may be beneficial to reduce inflammation and improve symptoms within 6-12 hours [ 1 ]. Some key points to consider in the treatment of pediatric laryngitis include:
- Avoiding the routine empiric use of antibiotics, as they are only effective in bacterial infections and their misuse can lead to unnecessary costs, side effects, and contribute to antibiotic resistance [ 1 ]
- Identifying cases where antibiotics may be warranted, such as in immunosuppressed patients or those with confirmed bacterial infections [ 1 ]
- Maintaining a calm environment and avoiding irritants like smoke or strong odors to prevent worsening of symptoms
- Recognizing that most cases of pediatric laryngitis are self-limiting and resolve within 7-10 days with appropriate supportive care [ 1 ]. Severe cases with stridor or respiratory distress require immediate medical attention and may need hospitalization for observation, oxygen therapy, or rarely, intubation.
From the Research
Treatment Options
- The treatment of pediatric laryngitis typically involves the use of glucocorticoids and inhaled racemic adrenalin in emergency services 2.
- A single dose of oral, intramuscular, or intravenous dexamethasone has been shown to improve symptoms and reduce return visits and length of hospitalization in children with croup of any severity 3.
- In patients with moderate to severe croup, the addition of nebulized epinephrine improves symptoms and reduces length of hospitalization 3.
Use of Dexamethasone
- Dexamethasone has been found to be effective in reducing the severity of illness within 24 hours after treatment in children with viral croup 4.
- A single dose of oral dexamethasone has been shown to reduce the pain associated with moderate to severe pharyngitis in pediatric patients 5.
- Dexamethasone has also been found to provide accelerated pain relief for sore throat in children, especially in those with severe or exudative group A β-hemolytic streptococcus-positive acute pharyngitis 6.
Management
- Most patients with pediatric laryngitis can be nursed at home 2.
- Laboratory studies are seldom needed for diagnosis of croup, and viral cultures and rapid antigen testing have minimal impact on management 3.
- Radiography and laryngoscopy should be reserved for patients in whom alternative diagnoses are suspected 3.