What is the recommended dose of prednisolone (corticosteroid) for a 5-year-old pediatric patient weighing 16.7 kg?

Prednisolone Dosing for a 5-Year-Old Child Weighing 16.7 kg

For acute asthma exacerbations, give 1-2 mg/kg/day as a single morning dose, which equals 17-33 mg daily for this child (typically rounded to 20-30 mg), with a maximum of 60 mg/day. 1, 2, 3

Condition-Specific Dosing Calculations

The appropriate dose depends entirely on the clinical indication:

For Acute Asthma Exacerbation (Most Common Pediatric Indication)

• Standard dose: 1-2 mg/kg/day = 17-33 mg daily 1, 2, 3
• Practical dosing: 20-30 mg once daily in the morning 2, 4
• Maximum dose: 60 mg/day 4, 3
• Duration: 3-10 days without need for tapering if used <10 days 1, 3
• Clinical evidence shows 2 mg/kg (33 mg for this child) effectively reduces symptoms and hospital stay 5, 6

For Other Pediatric Conditions

Moderate inflammatory conditions:

• 0.3 mg/kg/day = 5 mg daily 2

Moderate-severe inflammatory conditions:

• 0.5 mg/kg/day = 8.4 mg daily (round to 8-10 mg) 2

Severe inflammatory conditions:

• 0.75-1 mg/kg/day = 12.5-17 mg daily 2

Autoimmune hepatitis (initial treatment):

• 2 mg/kg/day = 33 mg daily (maximum 60 mg) 1
• Taper over 6-8 weeks to 0.1-0.2 mg/kg daily (2-3 mg) for maintenance 1

Nephrotic syndrome:

• 2 mg/kg/day = 33 mg daily (maximum 60 mg) as single morning dose 2, 3
• Continue for 4-6 weeks, then switch to alternate-day dosing 2

Critical Dosing Principles

Administration timing:

• Always give as a single morning dose to minimize adrenocortical suppression and mimic physiologic cortisol secretion 2, 4, 3
• Exception: If behavioral side effects (hyperactivity, emotional lability) occur, consider afternoon dosing after school 1

Weight-based considerations:

• This child's weight (16.7 kg) is appropriate for age, so use actual body weight for calculations 2
• For significantly overweight children, use ideal body weight to avoid excessive steroid exposure 2

Maximum dose cap:

• Never exceed 60 mg/day regardless of weight-based calculation 1, 2, 4, 3

Practical Dosing Algorithm

1. Identify the condition requiring treatment
2. Calculate weight-based dose using the condition-specific mg/kg recommendation
3. Round to practical tablet sizes (typically 5 mg tablets: round to nearest 5 mg increment)
4. Verify dose does not exceed 60 mg maximum 4, 3
5. Administer as single morning dose 2, 4

Common Pitfalls to Avoid

Divided dosing:

• Do NOT divide doses throughout the day unless specifically indicated 2, 4, 3
• Single morning dosing is superior for minimizing adrenal suppression 4

Unnecessary tapering:

• If treatment duration <10 days, tapering is NOT required 1, 3
• For longer courses, taper by reducing 25-33% at appropriate intervals 2

Monitoring requirements:

• Monitor for Cushingoid features, growth deceleration, weight gain, hypertension, and gastric irritation 2
• Provide calcium and vitamin D supplementation during therapy 2
• For courses >2 weeks, implement osteoporosis prevention measures 1