What is the treatment for pediatric facial swelling using prednisone (corticosteroid)?

From the Guidelines

Prednisone is commonly used to treat pediatric facial swelling, with dosing typically ranging from 1-2 mg/kg/day (maximum 60 mg daily) for 3-5 days, as evidenced by studies such as 1 and 1. For most children with allergic reactions or inflammatory conditions causing facial swelling, a short course of 5-7 days is often sufficient, with tapering generally unnecessary for courses less than 7-10 days. The medication should be given with food to minimize gastrointestinal side effects. Parents should monitor for potential side effects including:

• Increased appetite
• Mood changes
• Sleep disturbances
• Rarely elevated blood glucose Prednisone works by suppressing inflammation through inhibition of inflammatory mediators and reducing immune system activity. While treating the facial swelling, it's essential to identify and address the underlying cause, which could include:
• Allergic reactions
• Infections
• Trauma
• Autoimmune conditions If swelling is severe, especially if accompanied by respiratory distress or difficulty swallowing, immediate medical attention is necessary as this could indicate anaphylaxis requiring epinephrine and emergency care, as suggested by 1. It's crucial to follow the most recent and highest quality study, which in this case is 1, to ensure the best outcome in terms of morbidity, mortality, and quality of life. The dosing regimen of prednisone 60 mg/m2 or 2 mg/kg (maximum of 60 mg/day) until the child has been in complete remission for at least 3 days, as recommended by 1 and 1, should be considered. However, the specific dosing and treatment duration may vary depending on the underlying condition and individual patient needs, emphasizing the importance of consulting the most recent and relevant guidelines, such as those provided by 1, 1, and 1.

From the FDA Drug Label

Pediatric patients who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity. The adverse effects of corticosteroids in pediatric patients are similar to those in adults (see ADVERSE REACTIONS) Like adults, pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and osteoporosis

The use of prednisone in pediatric patients may cause various adverse effects, including those related to growth velocity. However, facial swelling is not explicitly mentioned in the provided drug label as a specific adverse effect in pediatric patients.

• Key points to consider when using prednisone in pediatric patients include:
  • Monitoring growth velocity
  • Careful observation for adverse effects
  • Titration to the lowest effective dose 2

From the Research

Pediatric Facial Swelling and Prednisone

• The use of prednisone in pediatric facial swelling is not directly addressed in the provided studies, except in the context of anaphylaxis management 3 and antihistamine-resistant chronic urticaria 4.
• In the management of anaphylaxis, corticosteroids such as prednisone may be considered as adjunct medications after epinephrine administration 3.
• A study on antihistamine-resistant chronic urticaria found that a short course of oral prednisone was effective in inducing remission in nearly 50% of patients 4.
• However, the use of prednisone in pediatric facial swelling of odontogenic origin is not explicitly mentioned in the provided studies 5, 6.
• The management of odontogenic facial swellings in children typically involves antibiotics, surgical management, and supportive care 5, 6.

Odontogenic Facial Swellings in Children

• A prospective study found that 16% of children with odontogenic facial swellings required admission for intravenous antibiotics, surgical management, and supportive care 5.
• The study also found that management options for children with odontogenic facial swellings include admission to hospital, immediate surgical management, and initial management with oral antibiotics 5.
• A scoping review found that antibiotic regimes varied in the management of odontogenic facial swellings in children, with oral amoxicillin being the most frequently recommended first-line therapy 6.

Corticosteroids in Pediatric Patients

• A study on the use of chloral hydrate in pediatric sedation found that an initial dose of 48±2 mg/kg did not negatively affect the success rate of sedation or the need for additional sedative 7.
• However, this study did not address the use of corticosteroids such as prednisone in pediatric patients 7.