What is the appropriate prednisolone (corticosteroid) dosing for a child with a swollen upper airway, weighing 43 pounds?

Prednisolone Dosing for Pediatric Upper Airway Swelling

For a 43-pound (19.5 kg) child with upper airway swelling (croup or acute asthma exacerbation), administer prednisolone 1-2 mg/kg/day, which translates to 20-40 mg daily as a single dose, with a maximum of 40 mg/day. 1, 2

Weight-Based Calculation

• A 43-pound child weighs approximately 19.5 kg 1
• Using the standard dosing of 1-2 mg/kg/day: this equals 19.5-39 mg daily 1, 2
• Round to a practical dose of 20-40 mg once daily, not exceeding the 40 mg maximum for pediatric patients 1, 2
• The FDA label confirms pediatric dosing ranges from 0.14 to 2 mg/kg/day (4 to 60 mg/m²/day) depending on disease severity 2

Simplified Weight-Based Estimation

• For approximating body surface area-based dosing using only weight, the equation [2 × W + 8] estimates a 60 mg/m² dose 3
• For this 19.5 kg child: [2 × 19.5 + 8] = 47 mg, but cap at 40 mg maximum 1, 2
• This confirms that 40 mg is the appropriate upper limit for this weight 1

Duration and Monitoring

• Continue daily dosing until symptoms resolve and the child maintains clinical improvement 1, 2
• For asthma exacerbations specifically, the National Heart, Lung, and Blood Institute recommends continuing until peak expiratory flow reaches 80% of personal best or symptoms resolve, typically 3-10 days 2
• No evidence supports tapering after improvement in acute exacerbations 2

Concurrent Therapy Requirements

• Oral corticosteroids must be combined with aggressive bronchodilator therapy if this is asthma-related 1
• Administer nebulized albuterol/salbutamol 5 mg every 4 hours initially, increasing to every 15-30 minutes if not improving 1, 4
• Maintain oxygen saturation >92% with supplemental oxygen as needed 4

Critical Pitfalls to Avoid

• Do not exceed 40 mg daily maximum in pediatric patients, even if weight-based calculations suggest higher doses 1, 2
• Do not use ideal body weight for dosing calculations; use actual body weight up to the maximum dose 1
• Do not delay administration—corticosteroids should be given immediately in acute upper airway obstruction 5
• The risk of harm from short-term steroid therapy (24 hours or less) is negligible 5

Alternative Considerations

• For severe life-threatening airway obstruction, intravenous dexamethasone 1.0-1.5 mg/kg or methylprednisolone 5-7 mg/kg may be preferred for more rapid tissue delivery 5
• Dexamethasone has a longer half-life (36-72 hours) and may offer single-dose convenience, though prednisolone remains standard for most pediatric upper airway conditions 6