What is the typical dose of dexamethasone (corticosteroid) for a toddler with croup?

Dexamethasone Dosing for Toddlers with Croup

The recommended dose of dexamethasone for a toddler with croup is 0.6 mg/kg (maximum 16 mg) administered orally, intramuscularly, or intravenously as a single dose. 1

Dosing Considerations

• The American Academy of Pediatrics recommends a standard dose of 0.6 mg/kg (maximum 16 mg) for pediatric patients with croup 1
• Lower doses of dexamethasone (0.15 mg/kg) may be equally effective as the standard 0.6 mg/kg dose for moderate to severe croup 2, 3
• The single-dose regimen does not require tapering and does not cause significant adrenal suppression 1

Administration Routes

• Dexamethasone can be administered through multiple routes:
  • Oral administration is preferred for mild to moderate cases 4
  • Intramuscular or intravenous routes may be used when oral administration is not feasible 1
  • All routes appear to have similar efficacy 1

Timing and Duration of Action

• Onset of action begins as early as 30 minutes after administration 1
• Clinical duration of action is approximately 24-72 hours 1
• For intubated patients, administer dexamethasone at least 6 hours before anticipated extubation for optimal effect 1

Treatment Algorithm Based on Croup Severity

Mild Croup

• Administer single dose of dexamethasone 0.6 mg/kg (maximum 16 mg) 1
• Observe for 2-3 hours to ensure symptoms are improving 4
• No nebulized treatments needed 4

Moderate to Severe Croup

• Administer single dose of dexamethasone 0.6 mg/kg (maximum 16 mg) 1
• For significant respiratory distress, consider nebulized epinephrine (0.5 mL/kg of 1:1000 solution, maximum 5 mL) 5, 4
• If racemic epinephrine is unavailable, L-epinephrine (1:1000) can be substituted at the same dosage 5
• Consider hospital admission if three or more doses of nebulized epinephrine are required 4

Important Clinical Considerations

• Oral corticosteroids are recommended for all cases of croup, regardless of severity 4
• Normal saline nebulization is not recommended as primary treatment 4
• The effect of nebulized epinephrine is short-lived (1-2 hours), requiring close monitoring 4
• Patients should be observed for at least 2 hours after the last dose of nebulized epinephrine to assess for symptom rebound 4

Common Pitfalls to Avoid

• Discharging patients too early after nebulized epinephrine (before the 2-hour observation period) 4
• Failing to administer corticosteroids in mild cases 4
• Using nebulized epinephrine in children who are shortly to be discharged or on an outpatient basis due to risk of rebound symptoms 4
• Antihistamines, decongestants, and antibiotics have no proven effect on uncomplicated viral croup 6