Prednisolone Dosing for a 2-year 7-month-old Child with Rash
For a 2-year 7-month-old child weighing 17.2 kg with a rash, the recommended prednisolone dose is 0.5-1 mg/kg/day (8.6-17.2 mg/day), with a typical starting dose of 15 mg once daily for short-term treatment.
Dosing Calculation
The FDA-approved prednisolone dosing information provides clear guidance for pediatric patients with dermatological conditions 1:
- Initial pediatric dose range: 0.14 to 2 mg/kg/day in three or four divided doses
- For this 17.2 kg child, this translates to:
- Minimum dose: 0.14 × 17.2 = 2.4 mg/day
- Maximum dose: 2 × 17.2 = 34.4 mg/day
However, for dermatological conditions specifically, a more targeted approach is recommended:
- For rash/dermatitis: 0.5-1 mg/kg/day 2
- For this child: 8.6-17.2 mg/day
Administration Considerations
Single daily dose: Morning administration as a single dose is preferred over divided doses as it:
- Causes less adrenal suppression
- Is more convenient to administer
- Maintains equivalent efficacy to divided dosing 3
Duration: Short courses (3-10 days) are typically sufficient for most rash conditions 2
- No tapering is necessary for short courses under 10 days
- For courses longer than 10-14 days, tapering is recommended to prevent adrenal suppression
Formulation Options
For a young child, liquid formulation may be preferred:
- Prednisolone sodium phosphate oral solution (15 mg prednisolone base per 5 mL) 1
- For a 15 mg dose, administer 5 mL
Monitoring and Precautions
Monitor for:
- Clinical response (improvement in rash)
- Potential side effects (even with short courses)
- Blood pressure at follow-up visits
- Urine glucose if treatment extends beyond 1 week
Common side effects with short-term use:
- Increased appetite
- Mood changes
- Sleep disturbances
Special Considerations
If the rash is suspected to be associated with rhinovirus infection or the child has eczema, prednisolone may have additional benefits in reducing the risk of recurrent wheezing 4
If no improvement is seen within 5-7 days, consider:
- Increasing the dose by 50-100%
- Re-evaluating the diagnosis
- Consulting with a pediatric dermatologist
Remember that while the FDA label allows for a wide dosing range, clinical practice for dermatological conditions typically uses the lower end of the spectrum to minimize side effects while maintaining efficacy.