What is the recommended dose of prednisone (corticosteroid) for treating croup in a 5-year-old child?

Prednisone Dosing for Croup in a 5-Year-Old Child

For a 5-year-old child with croup, the recommended dose of prednisone is 1 mg/kg/day (typically as a single dose). 1

Corticosteroid Options for Croup

Corticosteroids are the mainstay treatment for croup in children, with several options available:

1. Prednisone: 1 mg/kg as a single dose 2
2. Dexamethasone: 0.6 mg/kg as a single dose (preferred option) 3
3. Nebulized budesonide: 2 mg via nebulizer 2

Comparative Effectiveness

• Dexamethasone is likely more effective than prednisone for croup treatment:
  • Children treated with prednisolone are more likely to re-present for medical care (29%) compared to those treated with dexamethasone (7%) 4
  • Dexamethasone probably reduces return visits or readmissions by almost half compared to prednisolone 3
  • Dexamethasone shows a 28% reduction in the need for supplemental glucocorticoids as additional treatment 3

Dosing Considerations

• For moderate-to-severe croup: Oral dexamethasone 0.6 mg/kg (maximum 10-12 mg) is the current recommendation due to ease of administration, availability, and low cost 5
• For mild croup: Lower doses of dexamethasone (0.15-0.3 mg/kg) may be effective 5
• Recent evidence suggests that a lower dose of dexamethasone (0.15 mg/kg) may be as effective as the standard dose (0.6 mg/kg) 3

Administration Route

• Oral administration is preferred for most cases
• Intramuscular administration should be reserved for patients who are vomiting or in severe respiratory distress 5
• Nebulized epinephrine (racemic epinephrine) can be used for acute airway edema in croup: 0.05 mL/kg of 2.25% solution (maximum 0.5 mL) in 2 mL normal saline 6

Duration of Treatment

A single dose of corticosteroid is typically sufficient for most cases of croup. The benefits of corticosteroids include:

• Reduction in croup symptoms at 2,6, and 12 hours after administration 3
• Shorter hospital stays
• Reduced rate of return visits or readmissions 3

Clinical Pearls and Pitfalls

• Pitfall: Using prednisolone instead of dexamethasone may result in higher rates of symptom recurrence and return visits
• Pearl: If dexamethasone is unavailable, prednisone at 1 mg/kg can be used, but parents should be counseled about the possibility of symptom recurrence
• Pearl: A single dose of corticosteroid is usually sufficient; prolonged courses are rarely needed for uncomplicated croup
• Pitfall: Failing to treat even mild croup with corticosteroids may lead to unnecessary return visits and symptom prolongation

For this 5-year-old child with croup, dexamethasone 0.6 mg/kg as a single oral dose would be the optimal first-line treatment, but if only prednisone is available, a dose of 1 mg/kg should be administered.