Prednisolone is NOT Indicated for Uncomplicated Upper Respiratory Infections in a 2-Year-Old
Prednisolone should not be prescribed for a typical upper respiratory infection (URI) in a 2-year-old child, as URIs are predominantly viral and do not benefit from corticosteroid therapy. 1
Why Corticosteroids Are Not Recommended for URIs
URIs are viral infections that resolve spontaneously without corticosteroid intervention, and antibiotics (let alone corticosteroids) provide no benefit for these self-limited conditions 1
The American Academy of Pediatrics emphasizes judicious prescribing principles that specifically discourage the use of medications, including corticosteroids, for viral respiratory infections where they provide no therapeutic benefit 1
Corticosteroids suppress the immune system, making children more susceptible to secondary infections and potentially masking signs of bacterial complications 2
Specific Contexts Where Prednisolone During URI Might Be Considered
The evidence you may have encountered about prednisolone during URIs applies only to very specific patient populations, not to otherwise healthy children:
Children with Nephrotic Syndrome Only
Prednisolone during URIs is only recommended for children with frequently relapsing or steroid-dependent nephrotic syndrome who are already on alternate-day prednisolone maintenance therapy 1
The 2025 KDIGO guidelines now recommend against routinely giving daily glucocorticoids during URIs even in these nephrotic syndrome patients, based on the PREDNOS2 study showing no benefit 1
However, three extra doses of low-dose prednisolone (0.5 mg/kg/day) may be considered in nephrotic syndrome patients with a history of repeated infection-associated relapses or significant steroid-related morbidity 1
Children with Severe Lower Airway Disease
One study showed benefit of prednisolone for virally-induced lower airway disease (wheezing, respiratory distress) in children 6-35 months, but this is not a simple URI—these children presented to the emergency department with significant respiratory compromise 3
This represents a completely different clinical scenario than an uncomplicated URI with rhinorrhea, congestion, and mild cough 3
Important Safety Concerns
Corticosteroids carry significant risks in young children, particularly with repeated or prolonged use:
Growth suppression can occur even at low systemic doses and without laboratory evidence of HPA axis suppression 2
Increased infection susceptibility, including potentially fatal courses of chickenpox and measles in non-immune children 2
Immunosuppression that may activate latent infections or allow dissemination of organisms 2
Metabolic effects including hyperglycemia, hypertension, and electrolyte disturbances 2
The Correct Approach to URI in a 2-Year-Old
Supportive care only: adequate hydration, antipyretics for fever/discomfort, nasal saline, and reassurance about the self-limited nature of viral URIs 1
Monitor for complications such as acute otitis media, bacterial sinusitis, or pneumonia that might warrant antibiotic therapy using stringent diagnostic criteria 1
Avoid unnecessary medications including corticosteroids, antibiotics, and over-the-counter cough/cold preparations 1
Common Pitfall to Avoid
Do not extrapolate evidence from specialized populations (nephrotic syndrome patients) to general pediatric practice. The studies showing potential benefit of prednisolone during URIs 4, 5, 6 exclusively enrolled children with steroid-dependent nephrotic syndrome already on maintenance corticosteroid therapy—a completely different clinical context than an otherwise healthy child with a URI 1