From the Guidelines
Croup treatment should prioritize reducing airway inflammation and supporting breathing, with a focus on oral dexamethasone (0.15-0.6 mg/kg) as the standard treatment for moderate to severe cases, as it reduces inflammation and symptoms within hours and lasts for several days 1.
Key Considerations
- For mild cases, home management includes keeping the child calm, providing cool mist from a humidifier, or taking them to a steamy bathroom, and exposure to cool night air can also help reduce inflammation.
- In emergency settings, nebulized epinephrine (racemic epinephrine 2.25% solution or L-epinephrine 1:1000 solution) may be used for temporary relief of severe symptoms, but observation is needed as symptoms can return, as noted in the guidelines for nebulizer therapy 1.
- Severe cases requiring persistent oxygen or with signs of respiratory failure may need hospitalization, although quality improvement interventions can reduce hospital admissions without increasing revisits 1.
Treatment Options
- Oral dexamethasone: 0.15-0.6 mg/kg, single dose, for moderate to severe croup.
- Nebulized epinephrine: 0.5 mL/kg of a 1:1000 solution, for temporary relief of severe symptoms in emergency settings.
- Home management: cool mist, humidifier, steamy bathroom, and cool night air for mild cases.
Important Notes
- Antibiotics are not effective unless there's a bacterial infection, as croup is typically viral.
- Parents should seek immediate medical attention if their child shows signs of breathing difficulty, including stridor at rest, retractions, or bluish skin color.
- The use of a clinical guideline and orderset can reduce hospital admissions for croup, as shown in a recent study 1.
From the Research
Treatment Options for Croup
- The primary treatment for croup typically involves a single dose of systemic dexamethasone combined with nebulized epinephrine 2.
- Corticosteroids, such as dexamethasone, are the mainstay of treatment for croup, and can decrease the intensity of symptoms regardless of severity 3, 4.
- Nebulized epinephrine is often used in conjunction with corticosteroids, particularly in cases of moderate to severe croup, to reduce the severity of symptoms 2, 4, 5.
- The optimal dose of nebulized epinephrine is still unclear, but studies suggest that low-dose epinephrine (0.1 mg/kg) may be as effective as conventional doses (0.5 mg/kg) in reducing croup symptoms 2.
- Heliox inhalation has shown some therapeutic benefit in children with moderate to severe croup, particularly when used in conjunction with corticosteroids, but its role in treatment remains uncertain 6, 3, 4.
Comparison of Treatment Effectiveness
- Studies have shown that dexamethasone is more effective than nebulized epinephrine in reducing croup symptoms and shortening hospital stays 5.
- A single dose of orally administered dexamethasone (0.15-0.6 mg/kg) is effective in treating croup, with smaller doses (0.15 mg/kg) being as effective as larger doses 4.
- Nebulized budesonide (2 mg) can be used as an alternative to oral dexamethasone in children who do not tolerate it 3.