How can I effectively manage a child with croup who presents with stridor at rest?

Management of a child with croup presenting with stridor at rest:

• Admit the child to hospital as stridor at rest indicates moderate to severe illness requiring close monitoring and treatment in a hospital setting.
• Administer a single dose of oral dexamethasone 0.15 mg/kg immediately to reduce airway inflammation.
• If the child is too unwell to take oral medication, consider alternatives such as inhaled budesonide (2 mg nebulised as a single dose) or intramuscular dexamethasone (0.6 mg/kg as a single dose).
• Provide controlled supplementary oxygen if there are symptoms of severe illness or impending respiratory failure.
• Monitor closely for signs of respiratory distress or failure, including persistent stridor, chest wall recession, agitation, or cyanosis.
• Advise parents/carers on the expected course, symptom monitoring, and when to seek emergency care, including if stridor is continuous, the child is restless or agitated, or shows signs of respiratory distress.

This approach aims to promptly reduce airway swelling, support oxygenation, and ensure safety through hospital observation and treatment.

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