From the Guidelines
Steroid therapies are acceptable for pediatric patients in specific clinical situations when benefits outweigh risks, with corticosteroids like prednisone and budesonide being commonly used options. When considering steroid therapies for pediatric patients, it is essential to weigh the benefits against the potential risks, particularly in terms of growth suppression, immunosuppression, and other side effects 1.
Key Considerations
- For acute asthma exacerbations, a 3-5 day course of oral prednisone (1-2 mg/kg/day, maximum 60mg) is standard, as seen in guidelines for asthma management 1.
- Inhaled corticosteroids, such as fluticasone, are preferred for long-term control of mild persistent asthma in children aged 5 and older, with doses ranging from 50-250 mcg, 1-2 puffs twice daily based on age 1.
- For inflammatory bowel disease, such as Crohn's disease, prednisone may be used at 1-2 mg/kg/day with gradual tapering over 8-12 weeks, with budesonide being an alternative option, especially for its potentially lower side effect profile on growth 1.
Administration and Monitoring
- Growth monitoring is crucial when administering steroids to children due to the risk of growth suppression with prolonged use.
- Other potential side effects include immunosuppression, mood changes, increased appetite, and adrenal suppression with longer courses.
- Steroids work by reducing inflammation through inhibition of inflammatory mediators and suppression of immune responses.
Recommendations
- For chronic conditions requiring long-term steroid use, steroid-sparing agents should be considered when possible, and the lowest effective dose should be used for the shortest duration necessary 1.
- The choice of steroid and dosing should be tailored to the individual child's condition, age, and response to therapy, considering the most recent and highest quality evidence available 1.
From the FDA Drug Label
The efficacy and safety of prednisolone in the pediatric population are based on the well-established course of effect of corticosteroids which is similar in pediatric and adult populations. Published studies provide evidence of efficacy and safety in pediatric patients for the treatment of nephrotic syndrome (>2 years of age), and aggressive lymphomas and leukemias (>1 month of age).
Acceptable steroid therapies for pediatric patients include:
- Prednisolone for the treatment of:
- Nephrotic syndrome (>2 years of age)
- Aggressive lymphomas and leukemias (>1 month of age) It is recommended to titrate to the lowest effective dose and monitor growth velocity to minimize potential growth effects of corticosteroids in children 2.
From the Research
Steroid Therapies for Pediatric Patients
- IV corticosteroids, such as methylprednisolone, are commonly prescribed to treat critically ill children with asthma 3
- The majority of pediatric intensivists (96%) prescribe IV methylprednisolone, with starting doses ranging from 1-4 mg/kg/d 3
- Corticosteroids, including dexamethasone and methylprednisolone, are used to treat various pediatric conditions, including acute asthma exacerbations, croup, and anaphylaxis 4, 5
- Dexamethasone has been shown to be safe and potentially effective in treating critical asthma in children, with no significant differences in efficacy or safety compared to methylprednisolone 5
Commonly Used Steroids
- Methylprednisolone: commonly prescribed for critically ill children with asthma, with starting doses ranging from 1-4 mg/kg/d 3
- Dexamethasone: used to treat critical asthma in children, with a dose of 0.25 mg/kg/dose every 6 hours for 48 hours 5
Considerations for Pediatric Patients
- Corticosteroids can have significant side effects in pediatric patients, including growth retardation, dermatological, psychiatric, and gastrointestinal effects 6, 7
- The use of corticosteroids in pediatric patients requires careful consideration of the potential benefits and risks, as well as close monitoring for adverse effects 6, 7