The PNP is evaluating a 2-year-old child with a 48-hour history of a dry, coarse cough and fever. Upon examination the child appears ill but non-toxic. The child has a harsh, forceful cough with intermittent stridorous breaths after a coughing spasm but no stridor at rest. The parents have been giving the child an expectorant and cough suppressant that have provided little relief. The PNP makes the diagnosis of croup without respiratory distress. Treatment for this child should include:

The PNP is evaluating a 2-year-old child with a 48-hour history of a dry, coarse cough and fever. Upon examination the child appears ill but non-toxic. The child has a harsh, forceful cough with intermittent stridorous breaths after a coughing spasm but no stridor at rest. The parents have been giving the child an expectorant and cough suppressant that have provided little relief. The PNP makes the diagnosis of croup without respiratory distress. Treatment for this child should include:

• A. Nebulized albuterol and expectorants
• B. Narcotic cough suppressant as needed, fever management, mist therapy, and rest
• C. Antibiotic therapy combined with steroids and an expectorant
• D. Continued use of an expectorant if helpful, oral steroids, mist therapy, and rest

Answer: (D)

Mild croup is best treated with anti-inflammatory therapy and supportive care rather than antibiotics or routine bronchodilators. This child has croup without respiratory distress—no stridor at rest, only intermittent stridor after a coughing spell—which means the priority is reducing airway inflammation and providing comfort. A course of oral steroids (such as dexamethasone) diminishes laryngeal edema quickly and can shorten the course of symptoms. Humidified air or mist therapy and rest are traditional supportive measures to help soothe the airway and keep the child comfortable. Continuing an expectorant if it seems helpful addresses parental treatment while not hindering care, though antibiotics aren’t indicated because this is viral, and narcotic cough suppressants should be avoided in young children. If the child deteriorates (stridor at rest or increasing work of breathing), escalate care with treatments like nebulized epinephrine and possible admission.

Mild croup is best treated with anti-inflammatory therapy and supportive care rather than antibiotics or routine bronchodilators. This child has croup without respiratory distress—no stridor at rest, only intermittent stridor after a coughing spell—which means the priority is reducing airway inflammation and providing comfort. A course of oral steroids (such as dexamethasone) diminishes laryngeal edema quickly and can shorten the course of symptoms. Humidified air or mist therapy and rest are traditional supportive measures to help soothe the airway and keep the child comfortable. Continuing an expectorant if it seems helpful addresses parental treatment while not hindering care, though antibiotics aren’t indicated because this is viral, and narcotic cough suppressants should be avoided in young children. If the child deteriorates (stridor at rest or increasing work of breathing), escalate care with treatments like nebulized epinephrine and possible admission.