Prednisolone Dosing for a 4-Year-Old Child Weighing 37 Pounds
For a 4-year-old weighing 37 pounds (16.8 kg), the appropriate prednisolone dose depends on the condition being treated, but for most common pediatric indications (such as asthma exacerbations), give 1-2 mg/kg/day, which equals 17-34 mg/day (approximately 5.5-11 mL of the 15 mg/5 mL solution), with a typical starting dose of 30 mg/day (10 mL) as a single morning dose. 1, 2
Calculation and Dosing Framework
Weight Conversion and Standard Dosing
- 37 pounds = 16.8 kg 1
- Standard pediatric dosing for most conditions: 1-2 mg/kg/day 3, 4, 1, 2
- For this child: 16.8 kg × 1 mg/kg = 16.8 mg (minimum) to 16.8 kg × 2 mg/kg = 33.6 mg (maximum) 1
- Volume calculation: Using 15 mg/5 mL concentration, this equals approximately 5.5-11 mL per day 2
Condition-Specific Dosing Recommendations
For Asthma Exacerbations (most common indication in this age group):
- Dose: 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 4, 1, 2
- For this 16.8 kg child: 17-34 mg/day (5.5-11 mL) 1
- No tapering needed for courses less than 10 days 1
- Administer as single daily morning dose 1
For Nephrotic Syndrome:
- Initial episode: 2 mg/kg/day (maximum 60 mg/day) for 4-6 weeks 3, 4, 1
- For this child: 33.6 mg/day (approximately 11 mL) 3
- Alternative BSA-based dosing: 60 mg/m²/day 3, 1
- Important caveat: Weight-based dosing may underdose younger/smaller children compared to BSA-based dosing 5, 6
Critical Dosing Considerations
Body Surface Area vs. Weight-Based Dosing
- For children under 30 kg, weight-based dosing (2 mg/kg) typically provides 10-20% less medication than BSA-based dosing (60 mg/m²) 5, 6
- This underdosing may increase the risk of frequent relapses in nephrotic syndrome 5
- Simplified equation for approximating 60 mg/m² dose using only weight: [2 × weight in kg + 8] 7
- For this 16.8 kg child: (2 × 16.8) + 8 = 41.6 mg (approximately 14 mL) 7
Maximum Dose and Safety
- Maximum daily dose is typically 60 mg, though up to 80 mg may be considered for specific conditions 3, 1
- For significantly overweight children, dose based on ideal body weight to avoid unnecessary steroid exposure 3, 4, 1
Administration Guidelines
Timing and Frequency
- Administer as a single daily dose in the morning to minimize adrenocortical suppression 3, 1
- For asthma: single or divided doses acceptable 2
- For nephrotic syndrome: single daily dose preferred 3, 1
Practical Volume Measurement
- Using 15 mg/5 mL concentration:
- 17 mg = 5.5 mL
- 30 mg = 10 mL (reasonable starting dose for most conditions)
- 34 mg = 11 mL
- 42 mg = 14 mL (if using BSA-based calculation) 2
Common Pitfalls to Avoid
- Do not underdose young children by reflexively using 2 mg/kg without considering BSA-based calculations, especially for nephrotic syndrome 5, 6
- Do not taper doses for short courses (<7-10 days) 1
- Do not use divided doses when single morning dosing is appropriate 3, 1
- Monitor for common side effects including Cushingoid features, growth deceleration, weight gain, hypertension, and gastric irritation with prolonged use 4