From the Research
Yes, steroids, particularly dexamethasone, are recommended for treating croup. A single dose of oral dexamethasone (0.15-0.6 mg/kg, maximum 10 mg) is the standard treatment for children with mild to severe croup, as supported by the most recent and highest quality study 1. For children who cannot take oral medication, intramuscular or nebulized dexamethasone can be used. Alternatively, prednisolone (1-2 mg/kg) or budesonide (2 mg nebulized) may be substituted. Steroids work by reducing airway inflammation and edema, which helps alleviate the characteristic barking cough and stridor. Benefits typically begin within 2-3 hours and last for several days, often matching the typical duration of croup symptoms. Even children with mild croup benefit from steroid treatment, as it reduces symptom severity, shortens illness duration, decreases return visits, and lowers hospitalization rates, as shown in studies 2, 3, 4. For severe cases with respiratory distress, nebulized epinephrine may be used alongside steroids, but these children require close monitoring as the epinephrine effect is temporary. Some key points to consider when treating croup with steroids include:
- The optimal dosage of dexamethasone has been investigated, with studies suggesting that 0.15 mg/kg and 0.6 mg/kg are equally effective 1
- Dexamethasone has been shown to reduce hospitalizations, length of illness, and subsequent treatments when compared with placebo 2
- Steroid-induced complications in croup are rare, making them a safe and effective treatment option 2