Mild Drowsiness at Bedtime in a 6-Year-Old with Croup Taking Dexamethasone
Mild drowsiness around bedtime in a child taking oral dexamethasone for croup is expected and does not require intervention—this is a normal response and the child can safely go to sleep. 1
Why This Is Expected and Safe
Dexamethasone does not cause significant sedation as a primary effect, but mild drowsiness at bedtime in a child with croup is typically related to the natural resolution of respiratory distress and the child's normal bedtime routine, not a concerning drug side effect. 1
The onset of action for dexamethasone begins as early as 30 minutes after administration, with clinical improvement evident by this time, which means by bedtime the child's breathing should be improving and they can rest more comfortably. 1, 2
A single dose of dexamethasone (0.6 mg/kg, maximum 16 mg) does not cause adrenal suppression or require tapering, making it safe for use without concern for systemic corticosteroid side effects. 1
What You Should Monitor Instead
Focus on respiratory status rather than mild drowsiness:
Check for stridor at rest—if the child has noisy breathing even when calm, this indicates ongoing airway obstruction. 3
Assess work of breathing—look for retractions (pulling in of the chest wall), nasal flaring, or rapid breathing that suggests respiratory distress. 3
Maintain oxygen saturation ≥94% if you have access to pulse oximetry. 3
Ensure the child can be easily aroused—mild drowsiness is fine, but the child should wake up normally if stimulated. 4
When to Seek Immediate Care
Go to the emergency department immediately if:
The child develops significant stridor at rest, severe retractions, or agitation despite the dexamethasone. 1
Oxygen saturation falls below 94% or the child appears cyanotic (blue coloring). 3
The child becomes difficult to arouse or excessively lethargic beyond normal sleepiness. 4
Symptoms worsen after initial improvement, which could indicate bacterial tracheitis or another serious condition. 3
Important Caveats
Dexamethasone has a duration of action of 24-72 hours, so you should expect continued improvement over the next day, not just immediate relief. 1
If symptoms persist or worsen within 24 hours, re-evaluation is necessary. 3
Do not confuse mild drowsiness with excessive sedation—the child should still be interactive and responsive before falling asleep normally at bedtime. 4