Side Effects of Prednisone in Children with Severe Asthma
None of the listed options (anorexia, weight loss, anemia and fever, or neurologic symptoms) are typical side effects of prednisone in children with asthma; instead, prednisone commonly causes increased appetite, weight gain, behavioral changes, and growth suppression.
Common Adverse Effects in Pediatric Asthma Patients
The actual side effects of oral corticosteroids like prednisone in children differ significantly from those listed in the question:
Behavioral and Psychiatric Effects
- Behavioral disturbances are among the most common side effects, including anxiety, hyperactivity, and aggressive behavior 1
- Anxiety occurs in approximately 1 in 6 children treated with prednisone (number needed to harm = 6.1) 1
- Aggressive behavior manifests in approximately 1 in 5 children (number needed to harm = 4.8) 1
- These behavioral effects are dose-dependent, occurring twice as frequently at 2 mg/kg/day compared to 1 mg/kg/day 1
Metabolic and Growth Effects
- Weight gain and increased appetite are typical, not weight loss or anorexia 2
- Growth suppression can occur with prolonged use, even at low systemic doses 2
- Growth velocity may be the most sensitive indicator of systemic corticosteroid exposure in children 2
Endocrine Effects
- Hypothalamic-pituitary-adrenal (HPA) axis suppression can develop, particularly with prolonged therapy 2
- This suppression may persist for up to 12 months after discontinuation 2
Other Systemic Effects
- Hypertension and fluid retention (not anemia) 2
- Increased calcium excretion and potential bone effects with long-term use 2
- Hyperglycemia (elevated blood sugar) 3
Important Clinical Considerations
Dosing Recommendations
- For acute asthma exacerbations in children, the recommended dose is 1-2 mg/kg/day (maximum 40 mg) for 5 days 3
- Lower doses (1 mg/kg/day) are preferred as they provide comparable benefits with significantly fewer behavioral side effects compared to 2 mg/kg/day 1
Monitoring Requirements
- Children on corticosteroid therapy require careful observation with frequent measurements of blood pressure, weight, height, and clinical evaluation 2
- Linear growth should be monitored in all pediatric patients receiving corticosteroids 2
Common Pitfall to Avoid
The question presents atypical side effects that do not reflect the actual adverse effect profile of prednisone. Clinicians should recognize that prednisone causes appetite stimulation and weight gain, not anorexia and weight loss 2. Fever would suggest infection (which corticosteroids can mask) rather than a direct drug effect 2.