What is the recommended dose of prednisone (corticosteroid) for an 11-month-old child with asthma?

Prednisone Dosing for an 11-Month-Old with Asthma

For an 11-month-old child with an asthma exacerbation, administer oral prednisone at 1-2 mg/kg per day (maximum 60 mg/day) for 3-10 days, with no tapering required for courses under 10 days. 1

Weight-Based Dosing Calculation

• Calculate the dose based on actual body weight: For an average 11-month-old weighing approximately 9-10 kg, this translates to 9-20 mg daily 1
• The maximum daily dose is 60 mg (updated from the previous 30 mg maximum in earlier guidelines) 1
• Administer as a single daily dose or divided into 2 doses 1

Duration of Treatment

• Continue for 3-10 days depending on severity and response 1
• For outpatient "burst" therapy, 3-5 days is typically sufficient 1
• No tapering is necessary for courses less than 10 days, especially if the child will be started on inhaled corticosteroids 1

Clinical Context for Prescribing

The decision to use systemic corticosteroids depends on severity assessment:

• Mild exacerbations: May not require systemic steroids if responding well to bronchodilators 1
• Moderate exacerbations: Prednisone indicated if symptoms persist despite initial bronchodilator therapy 1
• Severe exacerbations: Prednisone is essential alongside aggressive bronchodilator therapy 1

Critical Administration Details

• Give the first dose immediately upon recognition of an exacerbation requiring systemic steroids 1
• Use soluble prednisolone formulation for easier administration in infants 1
• Ensure the child can tolerate oral medication; if vomiting or unable to take oral medication, consider hospital admission 1

Concurrent Bronchodilator Therapy

Prednisone must always be combined with bronchodilator therapy:

• Salbutamol via MDI with spacer and face mask: 1 puff every few seconds up to 20 puffs maximum, or 2.5 mg nebulized 1
• For very young children (under 1 year), use half the standard nebulized dose 1
• Repeat bronchodilator every 20 minutes for the first hour if needed 1

Alternative Corticosteroid Option

Recent evidence supports dexamethasone as an alternative:

• Single-dose oral dexamethasone 0.3 mg/kg is non-inferior to 3-day prednisolone for acute exacerbations 2, 3
• Advantages include: Single dose eliminates compliance issues, no vomiting (compared to 11% vomiting rate with prednisolone), and better palatability 2
• Disadvantage: Slightly higher rate of requiring additional steroids within 14 days (13% vs 4%) 2

Common Pitfalls to Avoid

• Do not underdose: The 1-2 mg/kg range exists because higher doses (2 mg/kg) may be needed for more severe exacerbations 1
• Do not exceed 60 mg maximum daily dose even if weight-based calculation suggests higher 1
• Do not delay steroid administration while waiting for response to bronchodilators in moderate-to-severe cases 1
• Do not use aminophylline in children at home—it is no longer recommended in the outpatient setting 1

When to Refer to Hospital

Immediate hospital referral is indicated if:

• Failure to respond to initial bronchodilator and oral steroid therapy 1
• Severe breathlessness with increasing tiredness 1
• Inability of parents to administer treatment reliably at home 1
• No improvement after 5 days of treatment 1

Follow-Up Requirements

• Reassess within 48 hours if treated at home 1
• Ensure objective improvement (clinical assessment, oxygen saturation if available) before considering treatment adequate 1
• Provide written asthma action plan to parents 1