A mother reports her four-year-old son has developed a barking cough after cold-like symptoms. What should you administer?

The presentation of a barking cough in a child, especially following cold-like symptoms, is highly suggestive of croup, which is typically caused by viral infection leading to inflammation of the upper airways. The key characteristic of croup is the stridorous, barking cough associated with narrowing of the airway.

In the management of croup, nebulized epinephrine is an effective treatment option because it acts as a rapid-acting vasoconstrictor, reducing airway edema and improving airflow by causing bronchodilation. This intervention is particularly useful in moderate to severe cases of croup where there is significant respiratory distress or stridor at rest. Administering nebulized epinephrine can quickly alleviate symptoms and stabilize the child, making it a critical choice in this scenario.

Other treatment options have their roles, but they do not address the acute symptoms of croup as effectively as nebulized epinephrine does. Oral corticosteroids can also be beneficial for treating inflammation associated with croup but would take longer to exhibit their effects. Saline nebulization may provide symptomatic relief but does not significantly reduce airway swelling or improve airflow in the way that nebulized epinephrine does. Antihistamines are not effective for croup because they do not target