Prednisone Dose for Croup in a 7-Year-Old (24.6kg)
Do not use prednisone for croup—use dexamethasone 0.15 mg/kg (3.7 mg for this child) as a single oral dose instead, as prednisolone/prednisone is significantly less effective than dexamethasone for preventing re-presentation to medical care. 1
Why Dexamethasone Over Prednisone
Dexamethasone is superior to prednisolone in a head-to-head randomized trial: children treated with prednisolone 1 mg/kg had a 29% re-presentation rate compared to only 7% with dexamethasone 0.15 mg/kg—a clinically significant 22% absolute difference. 1
The evidence for prednisolone in croup is scant and shows no advantage over dexamethasone in community-based trials. 2
Dexamethasone 0.6 mg/kg has been the most studied dose, but dexamethasone 0.15 mg/kg appears to have similar efficacy and is now preferred due to lower total steroid exposure. 3, 4
Recommended Dosing Algorithm for Croup
For Mild to Moderate Croup (Most Common)
- Dexamethasone 0.15 mg/kg orally as a single dose (maximum 10-12 mg if using the higher 0.6 mg/kg dose). 4
- For this 24.6 kg child: 3.7 mg of dexamethasone orally once. 4
- Oral administration is preferred unless the child is vomiting or in severe respiratory distress. 5
For Severe Croup Requiring Intubation
- If oral administration is impossible, use intramuscular dexamethasone 0.6 mg/kg (15 mg for this child). 4
- For intubated patients, consider prednisolone 1 mg/kg every 12 hours (25 mg twice daily for this child) to decrease duration of intubation, though dexamethasone remains first-line. 3
Route of Administration
- Oral route is preferred and equally effective as intramuscular when the child can tolerate it. 4
- Reserve intramuscular dexamethasone for children who are vomiting or in severe respiratory distress unable to take oral medication. 5, 4
Critical Pitfalls to Avoid
Do not exceed 60 mg maximum dose for any corticosteroid in pediatric croup, though this is rarely relevant at standard dosing. 5
Do not use prednisolone/prednisone as first-line therapy—the evidence clearly favors dexamethasone for superior outcomes. 1
Do not use nebulized budesonide as first-line unless oral/IM dexamethasone is unavailable—while effective (2 mg dose), it's less practical than oral dexamethasone. 3, 4
Be aware that the only significant adverse effect of a single corticosteroid dose is increased risk of severe varicella infection in exposed children, though this risk is minimal. 3