What’s the ER treatment for croup?
Dexamethasone is a steroid given by mouth that reduces inflammation. It is a one-time dose given in the ER that is effective for about four days, so no further doses are needed at home. Dexamethasone takes several hours to really kick in, so we often use another medicine in the ER called racemic epinephrine. Racemic epinephrine is an inhaled medicine given with a nebulizer machine that also reduces the swelling of the voice box. It is the most effective medicine for bringing immediate relief for stridor.
Naturopathic pediatricians typically recommend rubbing your child’s chest with essential oils in a base oil like coconut oil. Some recommended essential oils for croup include tea tree, thyme and lavender. I highly recommend making a homemade vapor rub to have on hand for situations like this. (Note: Eucalyptus should be avoided in children 2 and under.) You can swap out essential oils as desired. Just always make sure to perform a small skin patch test (for example, on your child’s forearm) to rule out any possible allergic reactions.
Several trials of heliox have demonstrated no advantage over conventional modalities; however, other trials have shown it to be equally effective in moderate to severe croup when compared with racemic epinephrine. [ 40 , 41 , 42 ] Heliox has also been shown to improve symptoms in very severe croup that failed to improve with racemic epinephrine. Currently, the evidence is not sufficient to establish the beneficial effect of heliox in pediatric croup management. [ 43 ] However, heliox has been used during emergency transport of children with severe croup. Anecdotal evidence suggests that heliox does help relieve respiratory distress. [ 44 ]