Safety of Steroids for 16-Month-Old Children
Steroids can be used in 16-month-old children but should be used with caution, at the lowest effective dose, for the shortest duration necessary, and with careful monitoring for side effects.
Types of Steroids and Safety Considerations
Systemic Corticosteroids (Oral/Injectable)
- Systemic steroids are approved for use in children as young as 1 month of age for certain conditions like aggressive lymphomas and leukemias 1
- For children with severe asthma and wheezing, systemic steroids may be used for acute, widespread flares 2
- In Bell's palsy, the evidence for steroid use in children is inconclusive, as children were excluded from most treatment trials and show higher rates of spontaneous recovery than adults 3
Topical Corticosteroids
- Young children (0-6 years) are particularly vulnerable to hypothalamic-pituitary-adrenal (HPA) axis suppression due to their high body surface area-to-volume ratio 3
- High-potency or ultra-high-potency topical corticosteroids should be used with extreme caution in infants 3
- Prolonged use of potent topical steroids can lead to Cushing syndrome even in infants, as reported in a 9-month-old girl who developed severe adrenal suppression from long-term clobetasol propionate application 4
Inhaled Corticosteroids (ICS)
- Inhaled corticosteroids are systemically active even in young children (1-3 years) 5
- Studies have shown that fluticasone propionate and budesonide at 400 mcg daily doses can reduce lower leg growth in children 1-3 years old 5
Monitoring and Risk Management
Growth Monitoring
- Children treated with corticosteroids by any route may experience decreased growth velocity, even at low systemic doses 1
- Growth velocity may be a more sensitive indicator of systemic corticosteroid exposure than laboratory tests of HPA axis function 1
- Linear growth should be monitored regularly in children receiving corticosteroid treatment 1
Dose Considerations
- Children should be titrated to the lowest effective dose to minimize potential growth effects 1
- The potential growth effects of prolonged treatment should be weighed against clinical benefits and alternative treatment options 1
Additional Monitoring
- Pediatric patients should be carefully observed with frequent measurements of:
- Blood pressure
- Weight and height
- Intraocular pressure
- Clinical evaluation for infection
- Psychosocial disturbances
- Signs of thromboembolism, peptic ulcers, cataracts, and osteoporosis 1
Specific Recommendations by Condition
For Asthma
- For children under 5 years with asthma, inhaled steroids should be used with appropriate spacer devices 3
- When large volume spacers are used, actuate the metered dose inhaler (MDI) one puff at a time 3
- Every child given inhaled steroids from an MDI should use a large volume spacer to enhance deposition of the medication in the lungs 3
For Skin Conditions
- For pediatric patients with conditions like hidradenitis suppurativa, intralesional steroids may be used for acute, localized flares, taking into consideration the patient's age and procedural tolerance 3
- For facial or genital psoriasis in children, topical calcineurin inhibitors are preferred over topical steroids 3
Common Pitfalls and Caveats
Avoid high-potency topical steroids in sensitive areas: Especially on the face, genitalia, and intertriginous areas in young children 3
Be aware of cumulative steroid exposure: Children with multiple allergic conditions may receive steroids from multiple routes (inhaled, topical, nasal), increasing total systemic exposure 6
Monitor for adrenal suppression: While rare, adrenal insufficiency can occur in children receiving high doses of inhaled corticosteroids 6
Avoid abrupt discontinuation: Rebound flares can occur if high-potency corticosteroids are abruptly discontinued without transition to an appropriate alternative treatment 3
Vaccination considerations: If possible, routine administration of vaccines or toxoids should be deferred until corticosteroid therapy is discontinued 1
In conclusion, while steroids can be used in 16-month-old children when medically necessary, they should be prescribed at the lowest effective dose for the shortest duration possible, with appropriate monitoring for side effects, particularly effects on growth.