Prednisone Use in Infants: Age Considerations and Guidelines
Prednisone can be prescribed to infants as young as 1 year of age for most conditions, while infants younger than 1 year should be evaluated carefully as they may have different underlying conditions requiring specialized management.
Age-Based Recommendations for Prednisone Use
Infants Under 1 Year
- Children younger than 1 year are more likely to have different (often genetic) causes for conditions like nephrotic syndrome and should be managed differently 1
- Special caution is needed as adverse effects may be more significant in this age group
- For specific conditions like hemangiomas, prednisone has been used at doses of 5 mg/kg/day in infants, but with careful monitoring 2
Infants 1 Year and Older
- Prednisone can be prescribed at 2 mg/kg/day (maximum 60 mg/day) for conditions like nephrotic syndrome 1
- For autoimmune hepatitis in children, prednisone is administered at 2 mg/kg daily (up to 60 mg/day) 1
- Duchenne muscular dystrophy treatment typically begins at age ≥6 years with prednisone 0.75 mg/kg/day 1
Dosing Guidelines by Condition
Nephrotic Syndrome
- Initial treatment: 2 mg/kg/day (maximum 60 mg/day) 1, 3
- Maintenance: Taper over 6-8 weeks to 0.1-0.2 mg/kg daily or 5 mg daily 1
- For frequently relapsing or steroid-dependent cases: Use lowest dose to maintain remission without major adverse effects 1
Autoimmune Hepatitis
- Initial dose: 2 mg/kg daily (up to 60 mg/day) 1
- Maintenance: Taper over time based on clinical and laboratory response 1
Hemangiomas
- Higher dose of 5 mg/kg/day is more effective than 3 mg/kg/day 2
- Treatment duration: 6-8 weeks, up to 12 weeks in severe cases 2
Monitoring Requirements
Growth and Development
- Regular monitoring of growth velocity is essential as it may be a more sensitive indicator of systemic corticosteroid exposure than HPA axis function tests 4
- Height and weight should be measured frequently during treatment 4
Side Effects to Monitor
- Blood pressure at each clinic visit 1
- Glucose levels (urine dipstick for glucose) 1
- Signs of infection 4
- Intraocular pressure 4
- Bone density (for long-term use) 1
Important Precautions
Vaccination Considerations
- Routine administration of vaccines should be deferred until corticosteroid therapy is discontinued if possible 4
- Ensure immunization schedule is complete before initiating prednisone therapy 1
Tapering
- Never stop prednisone abruptly due to risk of adrenal insufficiency 1, 3
- Gradual tapering is essential, particularly after prolonged use 3
Special Populations
- For premature infants, evidence regarding safety and efficacy is limited, and prospective trials are needed 5
- Systemic corticosteroids showed no benefit in respiratory syncytial virus infections in infants 6
Long-term Considerations
- Long duration of corticosteroid therapy (>14 days) has been associated with worse neurodevelopmental outcomes in extremely preterm infants 7
- Short-term high-dose inhaled or systemic corticosteroid use does not appear to be associated with increased adverse events across organ systems, but uncertainties remain for recurrent use and growth outcomes 8
When prescribing prednisone for infants, carefully weigh the benefits against potential risks, use the minimum effective dose for the shortest duration possible, and implement appropriate monitoring protocols to minimize adverse effects on growth and development.