What is the appropriate prednisone (corticosteroid) dosing for a 5-year-old asthmatic child with an upper respiratory infection (URI) weighing 24.9 kg?

Prednisone Dosing for Asthmatic 5-Year-Old with URI

For this 24.9 kg child, administer oral prednisone at 1-2 mg/kg/day (25-50 mg daily, maximum 40 mg) for 3-5 days with no tapering required.

Weight-Based Calculation

• Calculate the dose using actual body weight: 24.9 kg × 1-2 mg/kg = 24.9-49.8 mg daily 1
• Cap the dose at 40 mg maximum for pediatric patients, as recommended by the British Thoracic Society guidelines 2, 3
• Administer as a single daily dose or divided into 2 doses 1

Duration of Treatment

• For outpatient management of URI-triggered asthma exacerbation, 3-5 days is typically sufficient 1, 3
• No tapering is necessary for courses under 10 days, especially if the child will be started on inhaled corticosteroids 1
• Continue until complete remission of symptoms for at least 3 days if more severe 3

Severity Assessment Before Prescribing

The decision to use systemic corticosteroids depends on exacerbation severity 1:

• Mild exacerbations: May not require systemic steroids 1
• Moderate exacerbations (too breathless to feed, respirations >50/min, pulse >140/min): Prednisone indicated 2, 1
• Severe/life-threatening features (PEF <33%, silent chest, cyanosis, exhaustion): Requires immediate prednisone alongside aggressive bronchodilator therapy 2, 1

Critical Administration Details

• Give the first dose immediately upon recognition of an exacerbation requiring systemic steroids 1
• Use a soluble prednisolone formulation for easier administration in young children 1
• Prednisone must always be combined with bronchodilator therapy (salbutamol 5 mg via nebulizer or 2.5 mg for young children, repeated every 4-6 hours) 2, 1

Common Pitfalls to Avoid

• Do not underdose: While the maximum is 40 mg, ensure adequate dosing at 1-2 mg/kg for this weight 1, 3
• Do not delay steroid administration while waiting for response to bronchodilators in moderate-to-severe cases 1
• Do not use ideal body weight for overweight children; use actual weight up to the 40 mg maximum 3
• Recognize that URI is the most common trigger for asthma exacerbations in this age group 2, 4

Concurrent Therapy Requirements

• Nebulized salbutamol (2.5-5 mg) every 4-6 hours initially, increasing frequency to every 30 minutes if not improving 2, 1
• Add ipratropium 100 mcg nebulized every 6 hours if severe or not responding 2
• High-flow oxygen to maintain SpO2 >92% if available 2

Follow-Up and Discharge Planning

• Reassess within 48 hours if treated at home to ensure objective improvement 1
• Ensure inhaler technique is checked and recorded 2, 3
• Provide written asthma action plan to parents 1, 3
• Schedule primary care follow-up within 1 week 2, 3

When to Refer to Hospital

Immediate hospital referral is indicated for 1:

• Failure to respond to initial bronchodilator and oral steroid therapy
• Severe breathlessness with increasing tiredness or exhaustion
• Life-threatening features (silent chest, cyanosis, altered consciousness)
• Inability of parents to administer treatment reliably at home
• No improvement after 5 days of treatment