Prednisolone Dosing for a 5-Year-Old Child
For a 5-year-old child weighing 20 kg, the recommended prednisolone dose is 1-2 mg/kg/day (20-40 mg daily) for most acute conditions, with a maximum of 60 mg/day, administered as a single morning dose. 1, 2
Condition-Specific Dosing Recommendations
Asthma Exacerbations
- Standard dose: 1-2 mg/kg/day (20-40 mg daily for a 20 kg child) for 3-10 days 1
- The maximum dose is 60 mg/day regardless of weight 1
- Administer as a single daily dose 2
- No tapering is required for courses less than 7-10 days 1
- Treatment should continue until symptoms resolve or peak expiratory flow reaches 80% of personal best 2
Nephrotic Syndrome
- Initial episode: 60 mg/m² per day OR 2 mg/kg/day (40 mg daily for a 20 kg child), maximum 60 mg/day 1, 3
- Continue daily dosing for 4-6 weeks until remission is achieved for at least 3 days 1
- After remission: Switch to alternate-day dosing at 40 mg/m² OR 1.5 mg/kg (30 mg for a 20 kg child) for at least 4 weeks, then taper over 2-5 months 1, 3
Other Inflammatory Conditions
- Moderate disease: 0.3 mg/kg/day (6 mg daily for a 20 kg child) 3
- Moderate-severe disease: 0.5 mg/kg/day (10 mg daily for a 20 kg child) 3
- Severe disease: 0.75-1 mg/kg/day (15-20 mg daily for a 20 kg child) 3
Practical Dosing Calculations
Weight-Based vs. Body Surface Area
- For a 20 kg child, body surface area is approximately 0.8 m² 4
- A simplified equation for 60 mg/m² dosing: [2 × weight in kg + 8] = 48 mg for a 20 kg child 4
- A simplified equation for 40 mg/m² dosing: [weight in kg + 11] = 31 mg for a 20 kg child 4
- These equations eliminate the need for height measurements and complex BSA calculations while maintaining accuracy within 3-4% 4
Administration Guidelines
Timing and Frequency
- Administer as a single morning dose to minimize adrenal axis suppression and mimic physiologic cortisol secretion 3, 2
- If behavioral side effects (hyperactivity, emotional lability) occur, consider afternoon dosing after school 3, 5
- For nephrotic syndrome maintenance, alternate-day dosing is preferred to reduce side effects 1
Tapering Protocol
- For courses longer than 10-14 days, implement a structured taper: 6
- For courses less than 7 days, no tapering is necessary, especially if the child is on inhaled corticosteroids 1
Critical Monitoring and Precautions
Important Caveats
- For significantly overweight children, calculate dose based on ideal body weight rather than actual weight to avoid excessive steroid exposure 1, 6
- Consider a practical maximum dose of 60-80 mg daily regardless of calculated dose 1
- Oral prednisolone is NOT recommended for viral-induced wheezing in preschool children presenting with mild-to-moderate symptoms, as it shows no benefit over placebo 7
Side Effects to Monitor
- Short-term: increased appetite, fluid retention, weight gain, mood alterations, hyperglycemia 1, 2
- Long-term (>2 weeks): growth suppression, adrenal axis suppression, bone density loss, Cushingoid features 1, 3
- Initiate calcium and vitamin D supplementation immediately when starting therapy lasting more than 2 weeks 3, 6
Adrenal Suppression Risk
- HPA axis suppression should be anticipated with doses >7.5 mg daily for more than 3 weeks 6
- For courses longer than 2-3 weeks, gradual tapering is essential to allow adrenal recovery 6, 2
Common Pitfalls to Avoid
- Do not use methylprednisolone dose packs for therapeutic dosing—they provide inadequate total steroid exposure (only 84 mg over 6 days) 6
- Avoid dosing based on actual weight in overweight children, as this leads to unnecessary steroid exposure 1, 6
- Do not automatically taper short courses (<7-10 days), as there is no evidence this prevents relapse 1, 2
- Ensure gastrointestinal absorption is not impaired before choosing oral over IV route; if absorption is normal, oral therapy is equivalent to IV 1