Prednisone Dosing for a 10-Year-Old with Asthma
For a 10-year-old child with an asthma exacerbation, give prednisone 1-2 mg/kg/day (maximum 60 mg/day) in 2 divided doses for 3-10 days, with no tapering needed for courses under 10 days. 1
Specific Dosing Algorithm
For Acute Exacerbations (Hospital or ED Setting)
- Start with 1-2 mg/kg/day divided into 2 doses (e.g., morning and evening), with an absolute maximum of 60 mg/day 1, 2
- Continue until peak expiratory flow (PEF) reaches 70% of predicted or personal best 1
- Typical duration is 3-10 days 1, 2
For Outpatient "Burst" Therapy
- Use 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1, 2
- This can be given as a single daily dose or divided into 2 doses 1
Practical Example for a 10-Year-Old
If the child weighs 30 kg:
- Dose range: 30-60 mg/day (1-2 mg/kg × 30 kg)
- Can give as 15-30 mg twice daily OR 30-60 mg once daily
- Maximum dose regardless of weight: 60 mg/day 1
Route of Administration
Oral prednisone is strongly preferred and equally effective as intravenous therapy 1, 2, 3
- No advantage to IV administration unless the child is vomiting or has impaired gastrointestinal absorption 1, 2
- Research demonstrates oral prednisone at 2 mg/kg/dose twice daily is equivalent to IV methylprednisolone in hospitalized children 3
Duration and Tapering
No tapering is necessary for courses lasting less than 10 days, especially if the child is on inhaled corticosteroids 1, 2
- For courses of 3-7 days, stop abruptly without taper 1
- For courses up to 10 days, tapering is probably unnecessary 1, 2
Important Clinical Considerations
Timing Matters
- Administer systemic corticosteroids early in moderate-to-severe exacerbations, as anti-inflammatory effects take 6-12 hours to become apparent 2
- Start immediately for severe exacerbations (respiratory rate >50 breaths/min, pulse >140 beats/min, PEF <50% predicted, too breathless to talk or feed) 1
Dose Ceiling Effect
- Higher doses beyond 2 mg/kg/day provide no additional benefit but increase adverse effects 1, 2
- The maximum of 60 mg/day is evidence-based and should not be exceeded 1
Alternative Corticosteroid Option
- Prednisolone 1-2 mg/kg/day (maximum 40 mg) can be used interchangeably with prednisone 1
- Dexamethasone 0.3-0.6 mg/kg as a single dose is an alternative that may improve compliance, though prednisone remains standard 4
Critical Pitfalls to Avoid
- Don't use arbitrarily short 3-day courses without assessing clinical response—evidence supports 5-10 days for most exacerbations 2
- Don't delay corticosteroid administration while waiting for other treatments; early use improves outcomes 2
- Don't taper short courses unnecessarily, as this may lead to underdosing during the critical recovery period 1, 2
- Don't exceed 60 mg/day total dose regardless of the child's weight, as higher doses show no additional benefit 1