What is the recommended daily dosing frequency of prednisolone (corticosteroid) for a 12 kg child?

Prednisolone Dosing Frequency for a 12 kg Child

Prednisolone should be administered as a single daily dose in the morning for a 12 kg child, regardless of the condition being treated. 1, 2, 3

Dosing Frequency Guidelines

Single Daily Dosing is Standard

• All major guidelines recommend once-daily administration of prednisolone for pediatric patients 4, 1, 3
• The single morning dose minimizes adrenocortical suppression and mimics physiologic cortisol secretion patterns 2
• The FDA label explicitly states that initial doses "may vary from 1.67 mL to 20 mL (5 to 60 mg prednisolone base) per day" as a single daily dose 3

Evidence Supporting Single Daily Dosing

• A prospective study of 41 nephrotic syndrome patients demonstrated that 77% responded to single-dose daily prednisolone (2 mg/kg), with mean response times comparable to historical divided-dose regimens 5
• Single daily dosing achieved remission in 9.6 days for initial episodes and 11.1 days for relapses, equivalent to divided-dose protocols 5
• The KDIGO guidelines specifically recommend "oral prednisone be administered as a single daily dose" at 60 mg/m² per day or 2 mg/kg per day 4

Divided Dosing: When It May Be Considered

Pediatric Nephrotic Syndrome Exception

• The FDA label mentions that for pediatric nephrotic syndrome, the standard regimen is "60 mg/m²/day given in three divided doses for 4 weeks" 3
• However, this divided-dose approach contradicts more recent guideline recommendations favoring single daily dosing 4, 1

Asthma Exacerbations

• For uncontrolled asthma, the National Heart, Lung, and Blood Institute recommends 1-2 mg/kg/day "in single or divided doses" 3
• Despite this flexibility, single daily dosing remains preferred for simplicity and adherence 1

Practical Application for a 12 kg Child

Calculation Based on Weight

• At 2 mg/kg/day: 24 mg once daily in the morning 4, 1
• At 1 mg/kg/day (for maintenance or relapse): 12 mg once daily 6

Calculation Based on Body Surface Area

• A 12 kg child has approximately 0.54 m² BSA
• At 60 mg/m²/day: approximately 32 mg once daily 4, 3
• At 40 mg/m²/day (alternate-day dosing): approximately 22 mg on alternate days 4

Critical Pitfalls to Avoid

• Do not automatically divide doses based on outdated FDA labeling that mentions divided dosing for nephrotic syndrome 3
• Do not exceed 60 mg total daily dose regardless of weight-based calculations 1, 2
• For significantly overweight children, dose based on ideal body weight to avoid steroid overexposure 1, 7
• Weight-based dosing (2 mg/kg/day) may result in relative underdosing compared to BSA-based dosing (60 mg/m²/day), which increases the risk of frequent relapses in nephrotic syndrome by 16.6% 8