Acute laryngotracheobronchitis (croup) is one of the most common childhood respiratory illnesses. Children with moderate to severe airway obstruction are traditionally admitted to hospital for observation and treatment. Corticosteroids are now frequently used in children with acute laryngotracheobronchitis. To assess the efficacy of a smaller dose of dexamethasone (0.15 mg/kg) as compared to the standard dose of oral dexamethasone (0.6 mg/kg) in children with croup. We performed a double-blind, randomized trial involving 72 children with acute laryngotracheobronchitis. One group of children had dexamethasone (0.6mg/kg) (group A) and the other group of children was treated with oral dexamethasone (0.15mg/kg) (group B). The severity of illness was assessed by a clinical croup score based on retractions, stridor, air entry, cyanosis and the level of consciousness. Reduction in croup score, hospitalization rate and admission and adrenaline usage were evaluated. The characteristics of both groups were a most similar at the base line, including, duration of symptoms, previous medication usage, and severity of illness. Most of the children (90%) being younger than 5 years of age. Seventy-two patients completed the study with 36 patients in each group. Twelve hours from the time of treatment, the patients in group A (0.6mg/kg oral dexamethasone) as well as the patients in group B (0.15mg/kg oral dexamethasone) had statistically significant decline in median croup score from 4.5 to 2 (p=0.01) and from 5 to 2 (p=0.01), respectively. The over all rate of hospitalization after treatment in group A (0.6 mg/kg dexa-methasone) was 15/36 children (41.6%) and in group B (0.15mg/kg dexamethasone) it was 14/36, (38.9%) and there was not statistically significant different from one another (p=0.36). The median hospital stay (hours) for group A was 28hr (12-50) and for group B was 26hr (14- 48). No statistical significant difference between the two groups was observed (t=-0.32, p=0.64). Other outcome measures were similar for the two groups. We conclude that oral dexamethasone in a dose of 0.15mg/kg is as effective as a dose of 0.6 mg/kg in relieving symptoms of acute croup in children and results in similar reduction in the croup score, the adrenaline usage and the overall hospital admission rate and the duration-stay.