When should I consider prescribing oral dexamethasone for a child with croup?

Consider prescribing oral dexamethasone for a child with croup in the following situations:

• For all children with mild croup, a single dose of oral dexamethasone 0.15 mg/kg should be given immediately.
• For children with severe croup, or mild croup that might cause complications, a single dose of oral dexamethasone 0.15 mg/kg should be administered before transfer to hospital.
• If the child is too unwell to take oral medication (e.g., persistent vomiting or severe respiratory distress), alternative routes such as inhaled budesonide or intramuscular dexamethasone may be considered.
• Hospital admission and corticosteroid treatment are recommended for children with moderate or severe illness or impending respiratory failure.

Parents/carers should be advised on the expected course of croup, symptom monitoring, and when to seek urgent care.

This approach is based on evidence that corticosteroids reduce symptoms and healthcare re-presentation rates, with oral dexamethasone 0.15 mg/kg now supported as the effective dose.

Oral dexamethasone is recommended for children aged 3 months to 6 years with croup symptoms.

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