What are the supportive care measures for a child with croup at home?

Supportive Home Care for Croup

For a child with croup managed at home, maintain adequate hydration through continued feeding, use saline nasal drops for congestion relief, keep the child comfortable with minimal handling, and ensure a reliable caregiver can monitor for worsening symptoms requiring immediate return to medical care. 1

Core Supportive Measures

Hydration and Feeding

• Continue normal feeding patterns with breast milk or formula to maintain hydration 2
• Adequate fluid intake is essential for managing croup symptoms 3
• Monitor for signs of dehydration, which would require immediate medical attention 2

Environmental Management

• Maintain at least 50% relative humidity in the child's room 4
• Elevate the head of the bed to provide comfort and optimize breathing 2
• Minimize environmental irritants, particularly tobacco smoke exposure 2
• Keep the child calm and comfortable, as agitation may worsen respiratory distress 1

Symptom Management

• Use saline nasal drops to help with nasal congestion 2
• Administer antipyretics (acetaminophen or ibuprofen) to keep the child comfortable and help with fever control 1, 3
• Minimal handling may reduce metabolic and oxygen requirements in ill children 1

What NOT to Do at Home

Ineffective or Harmful Interventions

• Do not use over-the-counter cough and cold medications in children under 2 years due to lack of efficacy and risk of serious adverse events, including death 2
• Cold air or cool mist exposure lacks evidence of benefit for croup symptoms 1, 5
• Do not use antihistamines, decongestants, or antibiotics, as they have no proven effect on uncomplicated viral croup 3
• Avoid chest physiotherapy, as it is not beneficial and should not be performed 1

Critical Warning Signs Requiring Immediate Medical Attention

Respiratory Distress Indicators

• Stridor at rest (noisy breathing even when calm) 6
• Increased work of breathing with retractions (chest pulling in), grunting, or nasal flaring 2
• Respiratory rate exceeding 70 breaths per minute 1, 2
• Cyanosis (blue discoloration of lips or skin) 6

Other Concerning Signs

• Inability to feed or drink 2
• Signs of dehydration (decreased urine output, dry mouth, lethargy) 2
• Fever development ≥38°C (100.4°F) 2
• Increasing agitation or exhaustion, which may indicate worsening hypoxia 1, 6
• No improvement or worsening after 48 hours 1

Caregiver Requirements and Education

Observation Capabilities

• A reliable family member must be able to monitor the child and recognize signs of deterioration 1
• Parents must be capable of returning immediately if the child worsens 1
• Ensure the family understands this is typically a self-limited viral illness resolving in 7-10 days 2

Infection Control

• Practice hand hygiene to prevent spread 2
• Avoid contact with sick individuals 2
• Keep the child home from daycare until symptoms improve 7

Common Pitfalls to Avoid

Do not assume all respiratory distress is croup—sudden onset without preceding upper respiratory symptoms may indicate foreign body aspiration rather than viral croup 1, 8. If the child was playing with small objects and suddenly developed stridor without antecedent illness, seek immediate emergency care 8.

Do not delay seeking care if symptoms worsen—croup can occasionally progress to life-threatening airway obstruction, and early recognition of deterioration is critical 5, 6. The threshold for returning to medical care should be low, particularly in children under 18 months 1.