Corticosteroid Treatment for Croup in Children

Introduction to Corticosteroid Therapy

The American Academy of Pediatrics recommends corticosteroids as adjunctive therapy for croup, with nebulized epinephrine remaining first-line for severe cases with significant respiratory distress, and for nebulized epinephrine, 0.5 mL/kg of 1:1000 solution (maximum 5 mL) can be administered by nebulizer 1, 2

For a 14kg child with croup, prednisolone can be given at 1 mg/kg as a single oral dose, which equals 14 mg, though dexamethasone is the preferred corticosteroid for this condition 1, 2
The use of liquid formulation is recommended if available, as it is more readily absorbed than tablets, particularly important if the child has difficulty swallowing or is at risk of vomiting 3
No tapering is required for single-dose or short courses under 7 days 3, 4

Corticosteroids, such as prednisolone or dexamethasone, are effective in reducing croup scores, shortening hospital stays, and reducing return visits, with single-dose therapy eliminating compliance issues inherent with multi-day courses 1, 2