How should I treat a 10‑kg child (6 months–6 years) with mild croup (barky cough, hoarse voice, no stridor at rest) – what oral dexamethasone dose is recommended?

Treatment for Mild Croup

For a 10-kg child with mild croup (barky cough, hoarse voice, no stridor at rest), administer a single oral dose of dexamethasone 0.6 mg/kg, which equals 6 mg for this child. 1, 2

Dosing Specifics

• Standard dose: 0.6 mg/kg orally (maximum 16 mg) 1, 2
• For your 10-kg patient: 0.6 mg/kg × 10 kg = 6 mg total dose 1
• Oral route is preferred when the child can tolerate it—equally effective as intramuscular injection and avoids injection pain 1, 2
• All three routes (oral, IM, IV) are equally effective 2

Expected Clinical Response

• Onset of action: as early as 30 minutes after administration 1, 3
• Duration of action: 24-72 hours of sustained relief 1, 2
• No tapering required for this single-dose regimen 1
• Does not cause significant adrenal suppression 1

Important Clinical Considerations for Mild Croup

For mild croup specifically (no stridor at rest), dexamethasone alone is sufficient—nebulized epinephrine is NOT indicated. 4, 2 The British Thoracic Society explicitly warns that nebulized epinephrine should not be used in children who are shortly to be discharged or on an outpatient basis, as its effect is short-lived (1-2 hours) and reserved for avoiding intubation or stabilizing children prior to intensive care transfer. 4

When to Escalate Treatment

• Reserve nebulized epinephrine for moderate to severe croup with significant respiratory distress (prominent stridor at rest, retractions, agitation) 2, 5
• If escalation becomes necessary: nebulized epinephrine 0.5 mL/kg of 1:1000 solution (maximum 5 mL) 2, 5
• Epinephrine provides immediate but short-term relief while dexamethasone provides longer-lasting benefit 1

Common Pitfalls to Avoid

• Do not use lower doses (0.15 mg/kg) as initial treatment—while some studies suggest equivalence 6, 7, the American Academy of Pediatrics standard recommendation remains 0.6 mg/kg 1, 2
• Do not use prednisolone instead of dexamethasone—prednisolone is less effective, with 29% re-presentation to medical care compared to 7% with dexamethasone 1
• Do not use dexamethasone for non-specific cough, chronic cough, or pertussis-associated cough—it provides no benefit in these conditions 1
• Do not use nebulized corticosteroids from hand-held inhalers with spacers—they are ineffective for croup 1

Home Care Instructions

• Adequate hydration and humidification 8
• Fever control as needed 8
• Antihistamines, decongestants, and antibiotics have no proven effect on uncomplicated viral croup 8
• Parents should return if respiratory distress worsens (stridor at rest, retractions, agitation) 9