Prednisone Dosing for Bronchospasm in a 10-Year-Old Child
Direct Answer
For a 75-pound (34 kg) child with bronchospasm related to upper respiratory infection or COVID-19, prednisone should be dosed at 1-2 mg/kg/day (34-68 mg daily) for 3-5 days, using the lowest effective dose to control symptoms. 1
Weight Conversion and Dosing Calculation
- 75 pounds = 34 kg (conversion factor: 1 kg = 2.2 pounds)
- Standard dose range: 1-2 mg/kg/day = 34-68 mg daily 1
- Practical dosing: Start with 40-50 mg daily (approximately 1.2-1.5 mg/kg/day), which represents a moderate dose appropriate for bronchospasm 1
COVID-19 Context Considerations
If COVID-19 exposure or infection is confirmed, glucocorticoids should still be used but with specific caveats:
- For asymptomatic or mild COVID-19: Continue glucocorticoids at the lowest effective dose to control respiratory symptoms and avoid adrenal insufficiency 1
- For symptomatic COVID-19: Glucocorticoids should be continued with effort to reduce to the lowest effective dose possible 1
- Do not delay treatment if the child has significant respiratory distress or bronchospasm, as this represents organ-threatening disease 1
Dosing Duration and Tapering
Short course therapy (3-5 days) is appropriate for acute bronchospasm:
- Treatment duration should be limited to less than 3 months, ideally much shorter for acute respiratory symptoms 2
- For courses under 2 weeks at this dose, abrupt discontinuation is generally safe 1
- Critical caveat: If the child has been on steroids for >1 month at >5 mg/day equivalent, assume adrenal suppression and taper appropriately 3
Practical Dosing Regimen
Recommended approach for this 34 kg child:
- Day 1-3: Prednisone 40-50 mg once daily in the morning
- Reassess at 72 hours: If bronchospasm resolves, discontinue after 3-5 days total
- If minimal improvement: Consider increasing to 60-68 mg daily (approaching 2 mg/kg/day) 1
- Maximum duration: Do not exceed 5-7 days for acute bronchospasm without reassessment
Alternative Calculation Methods
Body surface area (BSA)-based dosing can be approximated using weight-only equations:
- For 60 mg/m² dose: [2 × W + 8] = [2 × 34 + 8] = 76 mg 4
- For 40 mg/m² dose: [W + 11] = [34 + 11] = 45 mg 4
- These BSA-based calculations suggest a range of 45-76 mg, supporting the 40-68 mg range recommended above 4
Critical Safety Considerations
Adrenal insufficiency risk:
- Any child receiving >5 mg/day prednisone equivalent for >1 month should be assumed to have adrenal suppression 3
- During respiratory illness, cortisol requirements increase 5-fold (from 20 mg/day to 100 mg/day) 3
- Never abruptly discontinue steroids in a child with potential adrenal suppression 1, 3
Infection considerations:
- Glucocorticoids may increase risk of secondary infection and delay viral clearance in respiratory infections 1, 5
- However, for bronchospasm requiring treatment, the benefits of controlling respiratory symptoms outweigh these risks 1
- Monitor closely for bacterial superinfection, especially if symptoms worsen after initial improvement 5
Common Pitfalls to Avoid
Do not underdose based on fear of COVID-19:
- The evidence shows glucocorticoids should be continued for respiratory symptoms even with COVID-19 infection 1
- Inadequate dosing may lead to treatment failure and prolonged symptoms 1
Do not use weight-based dosing that ignores BSA in young children:
- Simple mg/kg dosing may underdose younger children compared to BSA-based calculations 4
- The equations provided above help approximate BSA-based dosing using only weight 4
Do not continue steroids beyond what is necessary:
- Long-term glucocorticoid therapy carries substantial risks including bone health deterioration and growth suppression in children 2
- Limit duration to shortest possible course (ideally <1 week for acute bronchospasm) 2
Do not forget stress dosing if child has been on chronic steroids: