From the Guidelines
For a six-year-old child weighing 23.7 kg with hives, I would recommend oral Prednisolone at a dose of 1 mg/kg/day, which equals approximately 23.7 mg daily. This dosage is based on the most recent and highest quality study available, which suggests the use of Prednisolone for such conditions 1. The treatment should be given orally and can be administered for a short course, typically 3-5 days, depending on the severity and response to treatment. Before considering steroids, it's worth trying an antihistamine like cetirizine (Zyrtec) or diphenhydramine (Benadryl) for mild to moderate hives, as suggested in the guidelines 1. However, for severe or persistent hives, steroids like Prednisolone are particularly helpful in reducing inflammation and suppressing the immune response that causes hives. It's essential to monitor for potential side effects, which may include increased appetite, mood changes, and sleep disturbances, especially with short-term use. If symptoms worsen or don't improve after 24-48 hours of treatment, it's crucial to seek medical attention promptly. Given the potential for severe reactions, it's also important to consider other treatments mentioned in the guidelines, such as oxygen, Normal saline, or lactated ringers, if necessary, as outlined in the study 1. Additionally, other medications like Diphenhydramine at 1.25 mg/kg/dose orally can be considered for initial treatment before moving to steroids, as per the guidelines 1. The choice of treatment should always prioritize minimizing morbidity, mortality, and improving the quality of life for the patient. In this case, the most recent guideline supports the use of Prednisolone for severe acute urticaria or angio-oedema, making it the preferred choice for a six-year-old child with hives 1. Key points to consider in the treatment plan include:
- The dosage and duration of Prednisolone treatment
- The potential side effects and the need for monitoring
- The importance of seeking medical attention if symptoms worsen or don't improve
- The consideration of other treatments before moving to steroids
- The prioritization of minimizing morbidity, mortality, and improving the quality of life for the patient.
From the Research
Treatment for Hives in Children
For a six-year-old child weighing 23.7 kg with hives, the following treatment options can be considered:
- Antihistamines are the mainstay of treatment for urticaria, including in children 2
- Second-generation antihistamines such as cetirizine, desloratadine, fexofenadine, levocetirizine, and loratadine are preferred due to their reduced sedative and anticholinergic effects 3, 2
- In cases where antihistamines are not effective, a short course of oral corticosteroids such as prednisone may be considered 4
- The dosage of prednisone for children is typically based on their weight, but the exact dosage is not specified in the provided studies
Considerations for Steroid Treatment
- Corticosteroids can be effective in treating antihistamine-resistant chronic urticaria, with nearly 50% of patients achieving remission after a single short course of prednisone 4
- However, the use of corticosteroids in children should be carefully considered due to potential side effects, and the dosage and duration of treatment should be determined by a healthcare professional
- There is limited information available on the use of steroids specifically for hives in children, and more research is needed to determine the safest and most effective treatment options 4, 5