What should be initiated for a child with mild inspiratory stridor and SpO2 of 84% on room air?

In the scenario where a child presents with mild inspiratory stridor and an oxygen saturation (SpO2) of 84% on room air, the most appropriate intervention is the initiation of cool mist oxygen therapy.

Cool mist therapy aims to provide symptomatic relief by humidifying the airways, which helps reduce inflammation and edema in the upper respiratory tract, often caused by conditions such as croup or mild upper airway obstruction. This supportive measure can ease breathing and improve comfort for the pediatric patient. The presence of stridor indicates some degree of upper airway narrowing, and providing cool mist can help alleviate this by cooling and moisturizing the airway, which may reduce further stridor and improve airflow.

While high-flow oxygen therapy is typically reserved for more severe cases of hypoxia or respiratory distress, in this situation, where the child has only mild stridor and low oxygen saturation, cool mist therapy is more appropriate because it specifically addresses the needs of the patient without the immediate escalation of oxygen delivery that may not be necessary. IV fluids could be considered if the child were dehydrated or unable to maintain hydration, but these do not directly address the immediate respiratory issues. Oral steroids may be beneficial in reducing inflammation over a longer period, especially in cases like croup, but