Prednisolone Dosing for a 14kg Child with Croup
For a 14kg child with croup, give prednisolone 1 mg/kg as a single oral dose, which equals 14 mg, though dexamethasone is the preferred corticosteroid for this condition. 1
Critical Context: Dexamethasone is Preferred Over Prednisolone
While you asked specifically about prednisolone, the evidence strongly favors dexamethasone as the superior corticosteroid for croup. 2, 3
- Prednisolone results in significantly higher rates of return to medical care (29%) compared to dexamethasone (7%) when given at equivalent potency doses. 2
- The difference in re-presentation rates was 22% (95% CI 8-35%), which is clinically significant. 2
- A Cochrane review confirms dexamethasone probably reduces return visits or readmissions by almost half compared to prednisolone (RR 0.55). 3
If Prednisolone Must Be Used
Dose: 1 mg/kg orally as a single dose 1, 4
- For your 14kg child: 14 mg prednisolone orally, given once 1
- This can be administered as a single daily dose 5
- Use liquid formulation if available, as it is more readily absorbed than tablets, particularly important if the child has difficulty swallowing or is at risk of vomiting 6
Alternative Dosing from Research
One study used prednisolone 2 mg/kg/day for 3 days (which would be 28 mg/day for 3 days in your patient), but this multi-dose regimen showed no advantage over single-dose dexamethasone and has compliance issues. 7
Strongly Recommended: Switch to Dexamethasone
Dexamethasone 0.15 mg/kg orally as a single dose is the evidence-based first choice 3
- For your 14kg child: 2.1 mg dexamethasone orally, given once 3
- This lower dose (0.15 mg/kg) is as effective as the higher dose (0.60 mg/kg) for most outcomes 3
- Single-dose therapy eliminates compliance issues inherent with multi-day prednisolone courses 7, 8
- Dexamethasone's longer half-life (36-72 hours vs 12-36 hours for prednisolone) provides sustained effect 8
Important Clinical Caveats
- Corticosteroids are adjunctive therapy only; nebulized epinephrine remains first-line for severe croup with significant respiratory distress 1
- For nebulized epinephrine if needed: 0.5 mL/kg of 1:1000 solution (maximum 5 mL) administered by nebulizer 1
- No tapering is required for single-dose or short courses under 7 days 6, 9
- The only significant adverse effect of a single corticosteroid dose is increased risk of severe varicella infection if exposed 4
- Glucocorticoids reduce croup scores at 2,6, and 12 hours, shorten hospital stays, and reduce return visits 3
Common Pitfall to Avoid
Do not use multi-day prednisolone regimens when single-dose dexamethasone is available and equally or more effective. The evidence clearly demonstrates inferior outcomes with prednisolone, and multi-dose regimens introduce unnecessary compliance issues. 2, 7, 3