A 3-year-old boy presents with barking cough, mild stridor, hoarseness, is afebrile with SpO2 98% on room air. What is the most appropriate treatment?

• A. Oral dexamethasone
• B. Antibiotics
• C. Nebulized epinephrine
• D. Humidified air

Answer: (A)

This presentation is classic for viral croup (laryngotracheitis): barking cough, mild stridor, hoarseness, and normal oxygen saturation in a 3-year-old. For mild croup, the main goal is reducing airway inflammation and subglottic edema to relieve airway narrowing. A single dose of dexamethasone is highly effective for this, with oral administration being convenient and effective (typical dose about 0.6 mg/kg, max around 10 mg). This corticosteroid helps shorten symptoms and decrease the likelihood of needing hospital admission.

Antibiotics aren’t indicated because croup is viral, so there’s no bacterial infection to treat. Nebulized epinephrine is reserved for more moderate to severe cases with noticeable distress or hypoxia; since this child is afebrile, normoxic, and has only mild stridor, this isn’t necessary. Humidified air has not shown clear benefit in improving outcomes and isn’t required here.

So, giving a single dose of oral dexamethasone effectively addresses the underlying inflammation and is the best initial management for this mild croup presentation.