From the Guidelines
The treatment for croup should prioritize reducing hospital admissions through the use of clinical guidelines and ordersets, as evidenced by a significant decrease in hospital admissions with no increase in revisits 1. When managing croup, the primary goal is to alleviate symptoms and prevent complications, thereby reducing morbidity, mortality, and improving quality of life.
Key Considerations
- For mild cases, supportive care at home, including exposure to cool mist from a humidifier or sitting in a steamy bathroom, can help ease breathing.
- Keeping the child calm is crucial as agitation can worsen symptoms.
- For moderate to severe cases, medications such as dexamethasone (0.6 mg/kg, maximum 10 mg) given as a single oral dose, are used to reduce inflammation in the airway.
Emergency Settings
- In emergency situations, nebulized epinephrine (racemic epinephrine 2.25% solution, 0.5 mL in 2.5 mL saline) may be administered for temporary relief of severe symptoms.
- Oxygen therapy is provided if oxygen levels are low, to prevent hypoxia and its consequences.
Monitoring and Follow-Up
- Most children improve within 3-5 days with appropriate treatment.
- Parents should seek immediate medical attention if their child exhibits severe breathing difficulty, drooling, blue-tinged skin, or appears extremely anxious, as these are signs of potential airway compromise. The approach to treating croup, as supported by the most recent and highest quality study 1, emphasizes the importance of clinical guidelines in reducing the need for hospital admissions, thereby improving outcomes for patients with croup.
From the Research
Treatment Options for Croup
- A single dose of corticosteroids is the first-line treatment for croup, resulting in fewer return visits and hospital admissions, shorter lengths of stay in the emergency department (ED) or hospital, and less need for supplemental medication 2
- A 0.15 mg/kg dose of oral dexamethasone is as effective as larger doses 2
- Nebulized racemic or L-epinephrine reduces severity of symptoms in moderate-to-severe croup 2, 3
- The addition of nebulized epinephrine improves symptoms and reduces length of hospitalization in patients with moderate to severe croup 3
- Glucocorticoids are effective by oral, parenteral or nebulized routes, and continue to provide the mainstay of therapy 4
Non-Recommended Treatments
- Humidified air provides no demonstrable benefit in the acute setting 2
- Antihistamines, decongestants, and antibiotics have no proven effect on uncomplicated viral croup 5
- The use of humidified oxygen remains controversial, as good data are lacking 4
- The role of heliox in moderate to severe croup remains uncertain, with limited-quality disease-oriented evidence 2, 6
Home Care
- Home care consists of adequate hydration and humidification and fever control 5