Management of mild to moderate croup
Mild to moderate croup (see Severity assessment of croup) can be treated in the community with a single dose of corticosteroid and nondrug management. The use of a single dose of corticosteroids in children with mild to moderate croup reduces hospital admission rates and prevents repeat presentations.
For initial treatment of mild to moderate croup, use:
1 prednisolone (or prednisone) 1 mg/kg orally (up to 50 mg), as a single dose croup, mild to moderate prednis ol one
OR
2 dexamethasone 0.15 mg/kg orally (up to 12 mg), as a single dose1. croup, mild to moderate dexamethasone
If oral steroids are not tolerated, consider:
budesonide 2 mg by inhalation via nebuliser; repeat every 12 hours for up to 48 hours, as required. croup, mild to moderate budesonide
Observe for at least 30 minutes after the dose of corticosteroid. If accessory muscle use, stridor at rest, or distress have not improved, treat as for severe croup.
If the child settles initially after treatment for mild to moderate croup, they can return home; advise parents or carers that if the child develops stridor at rest later the same day, they should go to hospital. Management as for severe croup is required.
Give paracetamol or ibuprofen if the child has pain and is irritable.
Cough suppressants such as codeine have no proven effect on the course or severity of croup, and can cause respiratory depression and increase sedation.
Antibiotics are not indicated for the management of uncomplicated croup.