What is the appropriate dosing of prednisolone (corticosteroid) in pediatric patients?

From the Guidelines

Pednisolone dosing for children should be initiated at 1-2 mg/kg daily, up to a maximum of 60 mg daily, as this is the most commonly recommended dose in various conditions, including autoimmune hepatitis and nephrotic syndrome, as seen in studies such as 1 and 1. When considering the treatment of pediatric patients, it's crucial to weigh the benefits and risks of corticosteroid therapy, including the potential impact on growth and development.

• The dosing of prednisolone can vary depending on the specific condition being treated, with higher doses often used for more severe conditions like nephrotic syndrome, as outlined in 1.
• For conditions such as autoimmune hepatitis, the use of prednisolone in combination with other immunosuppressive agents like azathioprine may be considered, as discussed in 1.
• In the management of nephrotic syndrome, guidelines such as those from the KDIGO and commentaries like 1 suggest specific regimens for initial treatment and relapses, emphasizing the importance of tapering and monitoring for side effects.
• It's also important to consider the formulation of prednisolone, with liquid formulations available for younger children, and to administer the medication with food to minimize gastrointestinal side effects.
• Tapering is necessary for longer treatment courses to prevent adrenal suppression, and growth monitoring is essential due to the potential effects of corticosteroids on linear growth in children, as noted in various studies including 1 and 1.
• Morning dosing is preferred for once-daily regimens to align with the body's natural cortisol rhythm and minimize hypothalamic-pituitary-adrenal axis suppression, a consideration in the management of pediatric patients on corticosteroids.

From the FDA Drug Label

In pediatric patients, the initial dose of prednisolone sodium phosphate oral solution may vary depending on the specific disease entity being treated. The range of initial doses is 0. 14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m2bsa/day). The standard regimen used to treat nephrotic syndrome in pediatric patients is 60 mg/m2/day given in three divided doses for 4 weeks, followed by 4 weeks of single dose alternate-day therapy at 40 mg/m2/day The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses

The pediatric dosing of prednisolone varies depending on the disease entity being treated.

• The initial dose range is 0.14 to 2 mg/kg/day in three or four divided doses.
• For nephrotic syndrome, the standard regimen is 60 mg/m2/day for 4 weeks, followed by 40 mg/m2/day alternate-day therapy for 4 weeks.
• For asthma, the NHLBI recommends 1-2 mg/kg/day in single or divided doses 2.

From the Research

Pediatric Prednisolone Dosing

• The appropriate dose of oral prednisolone for children with acute exacerbation of asthma is 0.5 mg kg-1 day-1, as recommended by a study published in 1998 3.
• A randomized double-blind noninferiority trial published in 2021 found that 1 mg/kg/day of oral prednisolone was not inferior to 2 mg/kg/day in terms of clinical improvement and recurrence of wheeze within 1 week in preschool children with acute moderate asthma exacerbations 4.
• Another study published in 2021 investigated the efficacy of inhaled corticosteroids (ICS) when added to intravenous corticosteroids in pediatric patients with acute severe asthma, but did not provide specific dosing recommendations for prednisolone 5.
• A single-center cohort study published in 2024 characterized intravenous methylprednisolone dosing regimens and clinical outcomes for children hospitalized for critical asthma, but did not provide specific recommendations for prednisolone dosing 6.
• The guidelines for the prevention and management of bronchial asthma published in 2025 provide recommendations for the use of corticosteroids in asthma management, but do not specify a particular dose of prednisolone for pediatric patients 7.

Key Findings

• The use of higher doses of prednisolone does not provide significant advantages in treating acute exacerbations of asthma in children 3.
• A dose of 1 mg/kg/day of oral prednisolone may be sufficient for preschool children with acute moderate asthma exacerbations, with less frequent vomiting compared to higher doses 4.
• The duration of continuous nebulized albuterol and PICU length of stay were shorter in children prescribed conservative-dose methylprednisolone (≤ 0.5 mg/kg/dose every 6 h) compared to those prescribed standard-dose methylprednisolone (> 0.5 mg/kg/dose every 6 h) 6.