A 3-year-old child presents with a 2-day history of low-grade fever, hoarseness, inspiratory stridor at rest, and a harsh barking seal-like cough. Auscultation reveals clear lung fields. Oxygen saturation is 96% on room air. What is the evidence-based first-line treatment?

Answer and explanation

Correct answer: A. Oral single-dose dexamethasone (0.15 to 0.6 mg/kg)

  1. Step 1: The clinical presentation of barking cough, hoarseness, and inspiratory stridor is classic for viral croup (laryngotracheobronchitis, most commonly parainfluenza virus).
  2. Step 2: A single dose of oral dexamethasone (0.15 to 0.6 mg/kg) reduces subglottic airway edema, hospital admission rates, and return visits.
  3. Step 3: Nebulized racemic or L-epinephrine is indicated for moderate-to-severe stridor at rest with retractions.
Answer
Oral single-dose dexamethasone (0.15 to 0.6 mg/kg).
Why not the others: 'Intravenous ampicillin-sulbactam' is inappropriate because croup is viral; 'Inhaled short-acting beta-2 agonist' is ineffective because the obstruction is subglottic rather than bronchial; 'Oral dextromethorphan syrup' provides no anti-inflammatory benefit and is contraindicated in acute airway obstruction.

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