What is the pediatric dosing for prednisolone (corticosteroid)?

Pediatric Dosing for Prednisolone

The standard pediatric dosing for prednisolone is 0.14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m²/day), with specific dosing regimens varying by condition. 1

General Dosing Guidelines

Prednisolone dosing in pediatric patients varies based on the specific condition being treated. The FDA-approved dosing provides the following framework:

• Initial dose range: 0.14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m²/day) 1
• Maximum dose: Generally capped at 60 mg/day for children 2
• Administration: Can be given as a single daily dose in the morning for most conditions 2

Condition-Specific Dosing

Nephrotic Syndrome

• Initial episode: 60 mg/m²/day (maximum 60 mg) as a single daily dose for 6 weeks, followed by 40 mg/m² on alternate days for 6 weeks, then tapering 2, 1
• Relapse: 60 mg/m²/day until remission (at least 3 consecutive days), then alternate-day dosing 3

Asthma Exacerbations

• NHLBI recommendation: 1-2 mg/kg/day in single or divided doses 1
• Duration: Continue until peak expiratory flow reaches 80% of personal best or symptoms resolve (typically 3-10 days) 1
• Lower dose option: Some research suggests 0.5 mg/kg/day may be effective for acute asthma exacerbations 4

Inflammatory Conditions

• Acute inflammatory conditions: 5-7 days course 2
• Severe conditions: 10-14 days with gradual tapering 2
• Chronic conditions: Longer courses with slower tapering 2

Dosing Methods: Weight vs. Body Surface Area

Body surface area (BSA) dosing is generally preferred over weight-based dosing, especially for younger children:

• Weight-based dosing may lead to relative underdosing in smaller children compared to BSA-based dosing 5
• For nephrotic syndrome, underdosing doesn't affect initial response but increases the likelihood of a frequently relapsing course 5

Simplified Equations for BSA-based Dosing

When BSA calculation isn't feasible, these equations can approximate BSA-based doses using only weight:

• For 60 mg/m²: [2 × Weight(kg) + 8] mg 6
• For 40 mg/m²: [Weight(kg) + 11] mg 6

Tapering Guidelines

• Standard tapering: Reduce by 5-10 mg weekly until reaching low doses 2
• For nephrotic syndrome: After 6 weeks of alternate-day therapy, taper by 10 mg/m² per week 2
• General principle: Always taper gradually to prevent adrenal crisis 2

Monitoring and Precautions

• Short-term therapy: Monitor for behavioral changes, weight gain, increased appetite, and mood swings 2
• Long-term therapy: Monitor weight, blood pressure, blood glucose, and watch for behavioral changes 2
• Extended use: Regular monitoring for osteoporosis, diabetes, hypertension, and other complications 2

Common Pitfalls to Avoid

1. Underdosing small children: Using weight-based dosing instead of BSA-based dosing can lead to underdosing in smaller children, potentially affecting treatment outcomes 5
2. Abrupt discontinuation: Always taper prednisolone gradually rather than stopping abruptly to prevent adrenal crisis 1
3. Ignoring condition-specific protocols: Different conditions require different dosing regimens and durations 2, 1
4. Inadequate monitoring: Failure to monitor for side effects, especially during long-term therapy 2

Remember that dosage requirements are variable and must be individualized based on the disease being treated and the patient's response 1.