What is the recommended treatment for a child between 6 months and 5-6 years old with mild croup and no significant past medical history?

Treatment of Mild Croup in Children

For a child with mild croup (stridor without retractions), administer a single oral dose of dexamethasone 0.6 mg/kg and provide supportive care at home. 1, 2

Corticosteroid Therapy (Primary Treatment)

• Dexamethasone 0.6 mg/kg orally as a single dose is the definitive treatment for mild croup, even when symptoms appear minimal 1, 2
• This single dose significantly reduces return visits to medical care (7.3% vs 15.3% without treatment), accelerates symptom resolution, and improves sleep and parental stress 2
• The benefits are consistent across all severity levels of croup, making corticosteroids appropriate for essentially all children presenting with croup 3, 2
• Alternative routes if oral administration is not tolerated: intramuscular dexamethasone 0.6 mg/kg or nebulized budesonide 2 mg 4, 3

Nebulized Epinephrine (NOT Indicated for Mild Croup)

• Racemic epinephrine or L-epinephrine should NOT be used in mild croup 1
• Reserve nebulized epinephrine (0.5 mL/kg of 1:1000 solution, maximum 5 mL) exclusively for children with significant stridor at rest, retractions, or respiratory distress 1, 4
• This represents moderate-to-severe croup, not the mild presentation described in your question 4, 3

Supportive Care Measures

• Fever management: Ibuprofen 10 mg/kg every 6 hours or acetaminophen 15 mg/kg every 4-6 hours to reduce metabolic demand and respiratory distress 1
• Adequate hydration: Ensure the child maintains oral fluid intake 5, 6
• Humidification: While commonly recommended, published evidence does not strongly support cool mist therapy, though it remains a traditional practice 3

What NOT to Do (Common Pitfalls)

• Do not prescribe antibiotics - viral croup does not benefit from antibiotics unless there is clear evidence of bacterial superinfection 5
• Do not use antihistamines or decongestants - these have no proven effect on uncomplicated viral croup 5
• Do not withhold dexamethasone based on mild severity - the landmark trial demonstrated clear benefits even in children with Westley scores ≤2 2

Reassessment and Red Flags

• Review the child in 1 hour after dexamethasone administration to ensure no progression to moderate or severe croup 6
• Instruct parents to return immediately if the child develops: oxygen saturation <92%, respiratory rate >50 breaths/minute, significant retractions, inability to maintain hydration, or toxic appearance 1, 7
• Most children with mild croup respond well to a single dose and can be safely managed at home 5, 2