Figure 1 is an algorithm for outpatient management of croup based on illness severity. 25 – 34 Keeping a symptomatic child calm by avoiding distressing procedures is important because agitation may worsen airway obstruction. Positioning the child so that he or she is comfortable is appropriate because no particular position has been shown to be more beneficial in the assessment. Oxygen should be administered when the child is hypoxic or in severe respiratory distress. Heliox, a helium-oxygen mixture, has been used to reduce airflow resistance and turbulence. Although case reports have been encouraging, a systematic review found insufficient evidence that heliox is beneficial for croup. 35 Likewise, studies do not support the routine use of exposure to cold air, antipyretics, analgesics, antitussives, decongestants, or prophylactic antibiotics.
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.