Warm Showers Do Not Help Croup
Current evidence shows no benefit from warm showers, steam inhalation, or humidified air for treating croup symptoms in children. 1
Why Steam and Humidity Are Not Recommended
Humidification therapy has not been proven beneficial for croup management. Despite being a traditional home remedy, controlled studies have failed to demonstrate any improvement in airway edema or symptom relief. 2
The lack of efficacy applies to all forms of humidity delivery—whether heated air, cool mist, or steam from a warm shower—none have shown clinical benefit for respiratory symptoms in croup. 1
While maintaining at least 50% relative humidity in a child's room was historically recommended, this practice is based on tradition rather than evidence of effectiveness. 3
What Actually Works: Evidence-Based Treatment
Instead of warm showers, give oral corticosteroids immediately—this is the only treatment proven effective for all severities of croup. 1, 4
For Mild Croup:
- Administer oral dexamethasone 0.15-0.6 mg/kg (maximum 10-12 mg) as a single dose. 4
- This is sufficient treatment; no nebulized medications are needed. 4
- Observe for 2-3 hours to ensure symptoms improve. 5
For Moderate to Severe Croup (stridor at rest, retractions, respiratory distress):
- Give oral dexamethasone PLUS nebulized epinephrine 0.5 mL/kg of 1:1000 solution (maximum 5 mL). 5, 4
- The epinephrine effect lasts only 1-2 hours with significant rebound risk. 5
- Mandatory 2-hour observation period after the last epinephrine dose before discharge. 5
Common Pitfalls to Avoid
Never rely on steam or humidity as treatment—this delays effective corticosteroid therapy and provides false reassurance to parents. 1, 2
Do not discharge a child within 2 hours of nebulized epinephrine administration due to rebound risk. 5, 4
Never use nebulized epinephrine in outpatient settings where immediate return to care is not feasible. 5, 4
Do not give over-the-counter cough medicines—they provide no benefit and may cause harm in young children. 6, 4
Supportive Care That Does Help
Provide supplemental oxygen to maintain SpO₂ ≥94% if the child shows respiratory distress. 1, 4
Encourage regular fluid intake to prevent dehydration. 4
Minimize handling of severely ill children to reduce metabolic oxygen demand. 1, 4
When to Seek Emergency Care
Parents should return immediately if the child develops: