From the Guidelines
Croup treatment primarily involves managing symptoms and ensuring adequate oxygenation, with a single dose of oral dexamethasone (0.6 mg/kg, maximum 10 mg) being the cornerstone of treatment for moderate to severe cases. For mild croup, home management with cool mist humidification and keeping the child calm is often sufficient. According to a recent study published in Pediatrics 1, the use of a clinical guideline and orderset can reduce hospital admissions for croup, with a relative decrease of 57% (95% CI: 24 to 89) in the rate of admission from the emergency department.
Key Treatment Points
- Oral dexamethasone (0.6 mg/kg, maximum 10 mg) is the primary treatment for moderate to severe croup, reducing inflammation in the upper airway 1.
- Nebulized epinephrine (racemic epinephrine 2.25% solution, 0.5 mL in 2.5 mL saline, or L-epinephrine 1:1000, 5 mL) provides temporary relief for severe respiratory distress, but its effects last only 1-2 hours.
- Children receiving epinephrine should be observed for at least 2-3 hours after treatment to ensure symptoms don't return.
- Hospitalization is necessary for children with persistent stridor at rest, significant respiratory distress, or oxygen saturation below 92%.
- Antibiotics are not indicated as croup is typically viral, usually caused by parainfluenza virus infection, which narrows the airway and produces the characteristic barking cough and inspiratory stridor.
Additional Considerations
- The study found a modest reduction in total charges of $150 per encounter on average, though this did not reach statistical significance 1.
- There were no significant changes in balancing measures, including inpatient airway interventions or length of stay (LOS), suggesting that the treatment approach did not lead to increased complications or longer hospital stays 1.
From the Research
Treatment Options for Croup
- The treatment for croup typically involves the use of corticosteroids, such as dexamethasone, to reduce inflammation and swelling in the airways 2, 3, 4.
- A single dose of dexamethasone (0.15 to 0.60 mg per kg) is recommended for all patients with croup, including those with mild disease 2, 4.
- Nebulized epinephrine is an accepted treatment for patients with moderate to severe croup 2, 3, 5.
- Heliox, a mixture of helium and oxygen, may be beneficial in the short term for children with moderate to severe croup treated with dexamethasone, but the evidence is limited and of low quality 6.
- Humidification therapy has not been proven beneficial in the treatment of croup 2.
- Antihistamines, decongestants, and antibiotics have no proven effect on uncomplicated viral croup 5.
Administration and Dosage
- Dexamethasone can be administered orally, intramuscularly, or intravenously, with a dose of 0.6 mg/kg (maximum 10-12 mg) recommended for moderate-to-severe croup 4.
- Lower doses of dexamethasone (0.15-0.3 mg/kg) may be used for patients with mild disease 4.
- Nebulized epinephrine can be given in a dose of 0.5 mL of 2.25% solution diluted in 2.5 mL of saline solution, and is safe for all ages 5.