Discharge Instructions for a 5-Year-Old with Croup
Parents should monitor their child closely for 48 hours after discharge, watching for worsening respiratory symptoms, and should return to medical care immediately if the child develops increased work of breathing, lethargy, or inability to drink fluids. 1
Understanding Croup
- Croup is a viral infection causing swelling around the vocal cords and windpipe
- Characterized by a barking cough, hoarse voice, and sometimes noisy breathing (stridor)
- Most cases resolve within 2 days with appropriate home care 1
- Peak symptoms typically occur at night
Home Management
Medications
- Give dexamethasone exactly as prescribed (typically a single dose of 0.15-0.6 mg/kg)
- Complete the full course if multiple doses were prescribed
- Do NOT give over-the-counter cough and cold medicines as they are ineffective for croup 2
- Use acetaminophen or ibuprofen as directed for fever or discomfort
Supportive Care
- Keep your child calm and comfortable (crying can worsen symptoms)
- Ensure adequate fluid intake to prevent dehydration
- Position your child in a way that's comfortable for breathing
- Humidified air may provide some comfort, though evidence for cool mist is limited 3
When to Return to the Hospital/Emergency Department
Return immediately if your child develops:
- Difficulty breathing or increased work of breathing
- Stridor (noisy breathing) at rest that persists or worsens
- Blue or dusky color around the lips or face
- Excessive drooling or difficulty swallowing
- Extreme irritability or lethargy
- Inability to drink fluids
- Fever above 102°F (39°C) that doesn't respond to fever-reducing medication
Follow-up Care
- Contact your pediatrician if symptoms are not improving after 48 hours 1
- Schedule a follow-up appointment as recommended by your doctor
- Most children recover completely within a week
Important Notes
- The effect of any nebulized epinephrine treatment received is short-lived (1-2 hours), so monitor closely for returning symptoms 1
- Croup can sometimes recur, especially at night
- Keep your child away from cigarette smoke and other irritants
Prevention for the Future
- Encourage good hand hygiene
- Avoid close contact with people who have respiratory infections
- Keep vaccinations up to date
Remember that while croup can be frightening, most cases can be managed successfully at home with proper care and monitoring.