Do you give home steroids, such as dexamethasone, for croup?

Dexamethasone for Croup in Children

A single dose of oral dexamethasone (0.6 mg/kg, maximum 16 mg) should be given to all children with croup, regardless of severity, for home management. 1, 2

Rationale and Evidence

• Dexamethasone is effective for all severities of croup, including mild cases, with significant reduction in return visits to medical care (7.3% vs 15.3% with placebo) 3
• The American Academy of Pediatrics recommends a standard dose of 0.6 mg/kg (maximum 16 mg) administered orally, intramuscularly, or intravenously 1
• Lower doses (0.15 mg/kg) have shown similar effectiveness to the standard dose (0.6 mg/kg) in hospitalized children with moderate to severe croup 4
• A single dose provides clinical effect lasting 24-72 hours with onset as early as 30 minutes after administration 1

Administration Options

• Oral administration is equally effective as intramuscular injection for outpatient management 5
• The single-dose regimen does not require tapering and does not cause significant adrenal suppression 1
• For children unable to take oral medication, intramuscular or intravenous administration is appropriate 1

Treatment Algorithm

1. Assess severity of croup based on presence of stridor, respiratory distress, and oxygen saturation 2
2. For all severity levels: Administer single dose of dexamethasone 0.6 mg/kg (maximum 16 mg) orally 1, 2
3. For moderate to severe cases (stridor at rest, respiratory distress):
   • Add nebulized epinephrine (0.5 mL/kg of 1:1000 solution, maximum 5 mL) 6, 2
   • Monitor for at least 2 hours after epinephrine administration to assess for rebound symptoms 2
   • Consider hospital admission if three or more doses of epinephrine are required 2

Home Care Instructions

• Dexamethasone provides relief for 24-72 hours and does not require additional doses 1
• Current evidence does not support the use of heated or humidified air for symptom relief 2
• Parents should seek medical attention if:
  • Child's symptoms worsen
  • Child has difficulty breathing
  • Child shows no improvement after 48 hours 2

Important Considerations

• Dexamethasone is more effective than nebulized epinephrine in reducing symptoms at 6 and 12 hours post-administration 7
• Nebulized epinephrine provides immediate but short-term relief (1-2 hours) and should not be used for home management due to risk of rebound symptoms 2
• The American Academy of Pediatrics advises against using codeine and dextromethorphan for treating any type of cough 8
• Radiographic studies are generally unnecessary and should be avoided unless there is concern for an alternative diagnosis 2