This handout is for pediatric croup (laryngotracheobronchitis). Your care team identified this based on: barky/"seal-bark" cough ± hoarse voice — classic croup recognition, typically nocturnal worsening after a uri prodrome (aap/cps pediatric croup cpg).
Other reasons your team may use this plan: inspiratory stridor in a 6 mo-6 yr child (at rest = moderate+ severity) (aap/cps pediatric croup cpg); 12-48 h uri prodrome then barky cough + stridor worse at night (aap/cps pediatric croup cpg); recurrent abrupt nocturnal barky cough with minimal fever (spasmodic croup) (contemporary croup reviews).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| dexamethasone | 0.15-0.6 mg/kg PO/IM/IV SINGLE dose (commonly 0.6 mg/kg; max 16 mg) — 0.15 mg/kg non-inferior in dose-finding trials; PO preferred (= IM efficacy, less invasive) | PO/IM/IV | single dose (all severities including mild) | Cochrane glucocorticoids-for-croup — ↓ Westley score at 6-12 h, ↓ return visits, ↓ admissions/LOS, ↓ subsequent epinephrine use; Bjornson NEJM established benefit specifically in MILD croup |
| prednisolone | 1-2 mg/kg PO once (consider a 2nd-day dose given shorter half-life vs dexamethasone) | PO | once ± 2nd-day dose | Acceptable alternative where dexamethasone is unavailable; shorter half-life may warrant a 2nd-day dose (Cochrane glucocorticoids-for-croup); RxCUI omitted pending RxNav validation per task contract |
| budesonide (nebulized) | 2 mg nebulized once | inhaled | single dose | Equivalent to oral dexamethasone in trials but costlier — reserved for the vomiting child / uncertain oral retention (Cochrane glucocorticoids-for-croup); RxCUI omitted pending RxNav validation per task contract |
Plan: Corticosteroids — single dose for ALL severities including mild (dexamethasone PO/IM/IV first-line; prednisolone alternative; nebulized budesonide if vomiting) (Cochrane glucocorticoids-for-croup; Bjornson NEJM mild-croup RCT; AAP/CPS pediatric croup CPG)
Call 911 or go to the nearest emergency room right away if you have:
Caregiver education (calm child, cool/humidified air comfort measure, course 3-7 d with nocturnal peak), return precautions (stridor at rest, marked retractions, drooling, lethargy, poor intake, cyanosis); recurrent/atypical or subglottic-stenosis flag → ENT / airway (flexible-or-rigid laryngoscopy/bronchoscopy) evaluation; complete antibiotics if bacterial tracheitis; primary-care follow-up (AAP/CPS pediatric croup CPG)
Guideline: Contemporary AAP / CPS / Alberta-Toronto pediatric croup CPG (Westley severity; dexamethasone for ALL severities; nebulized epinephrine + mandatory 3-4 h observation for moderate-severe; supportive care; bacterial-tracheitis pivot; return precautions) + Cochrane glucocorticoids-for-croup (Gates/Russell) + Bjornson NEJM mild-croup dexamethasone RCT + nebulized-epinephrine racemic-vs-L-epinephrine equivalence RCT; vancomycin AUC per Rybak IDSA 2020 for the bacterial-tracheitis branch