Pediatric Prednisone Dosing
For pediatric patients, prednisone should be dosed at 1-2 mg/kg/day with a maximum of 60 mg/day for most conditions, with specific regimens tailored to the underlying condition. 1
General Dosing Guidelines
- Standard pediatric dosing: 1-2 mg/kg/day (maximum 60 mg/day) 1
- For significantly overweight children: Base dosing on ideal body weight rather than actual weight to minimize adverse effects 1
- Administration: Single daily dose is preferred for most conditions 2
Condition-Specific Dosing
Asthma Exacerbations
- Dose: 1-2 mg/kg/day (maximum 60 mg) 1, 3
- Duration: 3-10 days 1
- Route: Oral administration is as effective as IV if gastrointestinal absorption is not impaired 1, 4
Nephrotic Syndrome
- Initial episode: 60 mg/m² per day (maximum 60 mg) as a single daily dose for 6 weeks 2
- Followed by: 40 mg/m² as a single morning dose on alternate days for 6 weeks 2
- Then: Taper at rate of 10 mg/m² per week to 5 mg on alternate days (total duration 16 weeks) 2
- Relapse treatment: 60 mg/m² (maximum 60 mg/day) daily until remission for at least 3 consecutive days 2
Alternative Calculation Method
For situations where height measurement is unavailable (needed for BSA calculation):
Duration of Treatment
Duration varies by condition:
- Asthma exacerbations: 3-10 days 1, 3
- Nephrotic syndrome: 16 weeks total for initial episode 2
- Dermatitis/rash: 2 weeks with tapering 1
- Colitis: 4-6 weeks with tapering 1
Monitoring Requirements
Pediatric patients on prednisone should be monitored for:
- Blood pressure
- Blood glucose levels
- Growth velocity (height and weight)
- Intraocular pressure
- Signs of infection
- Mood changes and sleep disturbances
- Presence of cushingoid features 1, 6
Important Considerations
Growth Effects
- Even low systemic doses can decrease growth velocity 6
- Growth velocity may be a more sensitive indicator of systemic corticosteroid exposure than HPA axis function tests 6
- Monitor linear growth in all pediatric patients on corticosteroids 6
- Titrate to lowest effective dose to minimize growth effects 6
Adverse Effects
- Pediatric patients experience similar adverse effects as adults 6
- Risk of diabetes mellitus, fluid retention, and hypertension should be carefully considered 6
- Potential for decreased growth velocity even at low doses 6
Special Populations
- For children <2 years: Limited data on safety and efficacy except in nephrotic syndrome (>2 years) and aggressive lymphomas/leukemias (>1 month) 6
- Avoid live vaccines during treatment 1
- Use with caution in patients with active infections 1
Alternative Corticosteroid Options
For certain conditions like asthma, a single dose of oral dexamethasone (0.6 mg/kg, maximum 18 mg) may be as effective as a 5-day course of twice-daily prednisone (1 mg/kg per dose, maximum 30 mg) 7, which may improve medication adherence in some pediatric patients.