What is the recommended dose of prednisolone (corticosteroid) for pediatric patients?

Pediatric Prednisolone Dosing Guidelines

The recommended dose of prednisolone for pediatric patients varies by condition, but generally ranges from 0.14 to 2 mg/kg/day (4 to 60 mg/m²/day) with a maximum daily dose of 60 mg. 1, 2, 3

General Dosing Principles

• Prednisolone and prednisone are equivalent medications and can be used interchangeably at the same dosage 2
• For significantly overweight children, dosing should be based on ideal body weight to avoid unnecessary steroid exposure 1, 2
• The maximum daily dose is typically 60 mg, though in specific conditions up to 80 mg may be considered 1
• Dosing requirements are variable and must be individualized based on the disease being treated and the patient's response 3

Condition-Specific Dosing

Nephrotic Syndrome

• First episode treatment: 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) as a single daily dose for 4-6 weeks, followed by 40 mg/m²/day or 1.5 mg/kg/day (maximum 40 mg) on alternate days for 2-5 months with tapering 1, 3
• For infrequent relapses: 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) until remission for at least 3 days, then 40 mg/m²/day or 1.5 mg/kg/day on alternate days for at least 4 weeks 1
• For frequent relapses/steroid-dependent cases: daily prednisolone until remission for 3 days, followed by alternate-day prednisolone for at least 3 months at the lowest effective dose 1

Asthma

• For acute exacerbations: 1-2 mg/kg/day (maximum 60 mg/day) as a single daily dose 4, 3
• The National Heart, Lung, and Blood Institute recommends 1-2 mg/kg/day for children with uncontrolled asthma 3
• Research suggests that lower doses (0.5 mg/kg/day) may be as effective as higher doses (2 mg/kg/day) for treating acute asthma exacerbations, with fewer side effects 5, 6
• "Burst therapy" should be continued until peak expiratory flow reaches 80% of personal best or symptoms resolve (usually 3-10 days) 3

Autoimmune Hepatitis

• Initial regimen: 1-2 mg/kg/day (maximum 60 mg/day) for two weeks, either alone or with azathioprine 1
• Maintenance: tapering over 6-8 weeks to 0.1-0.2 mg/kg/day or 5 mg/day 1

Administration Considerations

• For most conditions, administer as a single daily dose in the morning to minimize adrenocortical suppression 1
• After favorable response, determine maintenance dosage by decreasing initial dose in small decrements at appropriate intervals 3
• If treatment is to be stopped after long-term therapy, withdraw gradually rather than abruptly 3

Monitoring and Precautions

• Assess for steroid-related adverse effects regularly, especially with prolonged use 1, 2
• Monitor growth in children on long-term therapy 1
• Consider bone mineral densitometry for patients on long-term treatment 1, 2
• Common side effects include Cushingoid features, growth deceleration, weight gain, increased appetite, hypertension, and gastric irritation 4
• Consider corticosteroid-sparing agents for children with frequent relapses or steroid dependence who develop adverse effects 1, 2

Special Considerations

• Lower doses of prednisolone (1 mg/kg/day) may be as effective as higher doses (2 mg/kg/day) for acute moderate asthma exacerbations with fewer side effects like vomiting 6
• Despite guidelines recommending 1-2 mg/kg/day, some intensivists use higher doses (4 mg/kg/day) in critically ill asthmatic children based on clinical experience rather than evidence 7