Caveats: In the Cochrane review, glucocorticoid has been shown to reduce the revisits and/or (re)admission rates and to decrease epinephrine use as a rescue therapy. The seven trials in the ED show the most benefit of glucocorticoid, where the absolute risk difference is 10% (NNT = 10). In the inpatient setting this absolute risk difference was % (NNT = 15). The % absolute benefit in need for readmission (NNT=11) is impressive, but this is based on a 21% overall rate of readmission in children in the control groups in this review. The actual benefit for a child will depend upon how often croup children are readmitted at baseline in one’s institution. The Cochrane authors note that in their group of studies the average readmission rate among institutions was roughly 12%, which would suggest an average NNT of 17.
The Cochrane review examined other outcome measures, such as length of stay and clinical severity. The cumulative length of stay was shortened by glucocorticoids by just over 11 hours in the combined inpatient (8 trials) and outpatient (1 trial) trials. Leipzig (1979) was the sole ED trial, however these study patients were admitted to the inpatient floors.
Finally, glucocorticoid treatment reduced clinical severity as measured by Westley scores. Children have a better clinical outcome according to the Westley score at the 6-hour and 12-hour mark (- and - points, respectively). A score reduction of 1 unit from baseline is deemed to be clinically significant.
Overall, the Cochrane review suggests that 5 patients would need to be treated with glucocorticoid for 1 patient to experience some measurable clinical benefit. The benefits are lower Westley score, fewer visits and/or (re)admission, decreased length of stay, or decreased usage of epinephrine as rescue therapy.
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.
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.