Treatment of Croup in Children

Assessment and Treatment

Evaluate for stridor at rest, respiratory distress, or increased work of breathing, and check oxygen saturation (maintain ≥94%) in a child with croup, according to Praxis Medical Insights 1
Assess for signs of dehydration or fatigue in a child with croup, as recommended by Praxis Medical Insights 1
The American Academy of Pediatrics recommends nebulized epinephrine for significant respiratory distress in children with croup, with a dosage of 0.5 mL/kg of 1:1000 solution (maximum: 5 mL) administered by nebulizer, as suggested by Praxis Medical Insights 1, 2
If racemic epinephrine is not available, L-epinephrine (1:1000) can be substituted at the same dosage for a child with croup, according to Praxis Medical Insights 2
The effect of nebulized epinephrine is short-lived, lasting approximately 1-2 hours in children with croup, as noted by Praxis Medical Insights 1
Administer oxygen therapy if oxygen saturation falls below 94% in a child with croup, as recommended by Praxis Medical Insights 1
Do not use nebulized epinephrine in children who are shortly to be discharged or on an outpatient basis due to risk of rebound symptoms, as advised by Praxis Medical Insights 1
Do not use corticosteroids from hand-held inhalers with spacer devices as they have not been shown to be effective for croup, according to Praxis Medical Insights 3

Consider hospital admission if three or more doses of racemic epinephrine are required, or if there is persistent respiratory distress despite treatment, or if oxygen is required to maintain saturation ≥94% in a child with croup, as recommended by Praxis Medical Insights 1
Re-evaluate the child within 24 hours if symptoms persist, as suggested by the Chest journal 4
If symptoms worsen after initial improvement, prompt reassessment is necessary to rule out alternative diagnoses such as bacterial tracheitis or foreign body aspiration in a child with croup, according to Praxis Medical Insights 1