How can I manage mild croup at home in a child?

Home Management of Mild Croup in Children

For mild croup at home, give your child a single dose of oral dexamethasone (0.15-0.6 mg/kg, maximum 10-12 mg) and focus on comfort measures including fluids and fever control—skip the humidifiers and cold air, as they don't work. 1, 2

Immediate Treatment Steps

Medication:

• Administer oral dexamethasone as a single dose at 0.15-0.6 mg/kg (maximum 10-12 mg) even for mild cases, as this reduces symptom severity and prevents progression. 1, 3, 2
• This is the only medication proven to help; do not use over-the-counter cough or cold medicines, as they provide no benefit and may cause harm. 4
• Never give aspirin to children under 16 years due to risk of Reye's syndrome. 5, 6

Comfort and Supportive Care:

• Use acetaminophen (paracetamol) at 10-15 mg/kg every 4-6 hours (maximum 5 doses in 24 hours) to keep your child comfortable, not necessarily to eliminate fever completely. 6
• Encourage regular fluid intake to prevent dehydration, but avoid forcing fluids if the child is vomiting. 5, 6
• Allow your child to rest in whatever position is most comfortable—forcing them to lie down may worsen breathing. 4

What NOT to Do (Common Pitfalls)

• Do not use humidifiers, steam, or cold air exposure—despite being traditional remedies, current evidence shows no benefit from heated or humidified air for croup symptoms. 4, 2
• Do not give antibiotics—croup is viral and antibiotics are ineffective and unnecessary. 1
• Avoid honey—it only helps post-viral cough, not the inflammatory airway obstruction of croup. 4
• Do not use antihistamines or decongestants—they are ineffective and carry potential adverse effects. 4

When to Seek Immediate Medical Care

Go to the emergency department immediately if your child develops any of these warning signs: 5, 1, 4

• Respiratory distress: Breathing rate >70 breaths/min in infants or >50 breaths/min in older children, visible chest wall pulling in with breathing, or grunting sounds. 5
• Stridor (harsh breathing sound) at rest or worsening stridor. 1, 7
• Cyanosis (blue lips or skin) or oxygen saturation <92% if you have a home monitor. 5, 1
• Extreme fatigue, lethargy, or difficulty staying awake—this is a critical warning sign. 1
• Inability to drink fluids or signs of dehydration. 5
• Agitation or restlessness—this may indicate low oxygen levels, not just anxiety. 5, 4

Follow-Up and Monitoring

• Contact your doctor if symptoms don't improve within 48 hours or if they worsen at any time. 5, 4
• Most children improve significantly within 24-48 hours after dexamethasone. 2, 8
• The barking cough may persist for several days even as breathing improves—this is normal. 1
• Return immediately if breathing difficulty increases or if your child cannot maintain adequate hydration. 4

Understanding the Condition

Croup is caused by viral infection (most commonly parainfluenza virus) affecting children typically between 6 months and 6 years of age. 9, 3, 2 The characteristic "barking seal" cough and harsh breathing sound (stridor) result from swelling in the upper airway. 3, 7 While the cough sounds frightening, when properly treated and monitored, the airway remains open in most cases and children recover completely without long-term effects. 1

Key reassurance: The vast majority of croup cases are mild and resolve completely at home with a single dose of steroid and supportive care. 2, 8 Your child is not at risk of choking or dying from properly managed mild croup. 1