What is the treatment for croup in a 17 kg child?

Treatment of Croup in a 17 kg Child

Administer oral dexamethasone 0.15-0.6 mg/kg (2.55-10.2 mg for this 17 kg child, maximum 10-12 mg) as a single dose immediately, regardless of croup severity. 1, 2

Severity-Based Treatment Algorithm

Mild Croup (No Stridor at Rest)

• Give oral dexamethasone alone (0.15-0.6 mg/kg as single dose) 1, 3
• Observe for 2-3 hours to ensure symptoms are improving 3
• Do NOT use nebulized epinephrine in mild cases 1
• Discharge home if stridor remains absent at rest, respiratory distress is minimal, child can take oral fluids adequately, and parents understand return precautions 1

Moderate to Severe Croup (Stridor at Rest or Respiratory Distress)

• Administer oral dexamethasone PLUS nebulized epinephrine (0.5 ml/kg of 1:1000 solution, maximum 5 ml) 1, 4
• Nebulized epinephrine effects last only 1-2 hours, requiring close monitoring for rebound symptoms 3, 4
• Observe for at least 2 hours after the last epinephrine dose before considering discharge 3, 4
• Provide supplemental oxygen to maintain saturation >94% if needed 4

Hospitalization Criteria

Admit if ANY of the following are present:

• Three or more doses of nebulized epinephrine required 1, 3, 4
• Oxygen saturation <92% 1, 4
• Age <18 months 1
• Respiratory rate >70 breaths/min 1
• Persistent difficulty breathing despite treatment 1

Critical Pitfalls to Avoid

• Never discharge a child within 2 hours of receiving nebulized epinephrine due to rebound symptom risk 1, 3, 4
• Do not withhold corticosteroids in mild cases - they are indicated for ALL severities 1, 3
• Do not use nebulized epinephrine in outpatient settings where immediate discharge is planned 1, 3, 4
• Do not use antibiotics routinely, as croup is viral 1
• Do not rely on humidified air or cold air treatments - they lack evidence of benefit 4, 5

Discharge Instructions

Send home only when:

• Stridor has resolved at rest 1
• Minimal or no respiratory distress present 1
• Child tolerating oral intake 1
• Parents can recognize worsening symptoms (increased work of breathing, inability to drink, agitation suggesting hypoxia) 1, 4
• Instruct parents to return to emergency department if symptoms worsen or fail to improve within 48 hours 4

Supportive Care

• Use antipyretics for comfort and fever control 4
• Minimize handling to reduce oxygen requirements 4
• Ensure adequate hydration 6
• Avoid chest physiotherapy - it provides no benefit 4