From the Guidelines
Prednisolone dosing for pediatric patients should be initiated at 1-2 mg/kg/day, with a maximum daily dose of 60 mg, as recommended by the most recent and highest quality study 1. The dosing regimen may vary depending on the condition being treated, with acute asthma exacerbations typically requiring 1-2 mg/kg/day for 3-5 days, and inflammatory conditions like juvenile idiopathic arthritis requiring lower doses of 0.5-1 mg/kg/day for longer periods. Some key points to consider when prescribing prednisolone to pediatric patients include:
- The maximum daily dose should not exceed 60 mg
- The medication should be given with food to minimize gastrointestinal side effects
- Tapering is necessary for longer treatment courses (more than 1-2 weeks) to avoid adrenal suppression
- Side effects include increased appetite, mood changes, sleep disturbances, and with prolonged use, growth suppression and immunosuppression
- Prednisolone works by reducing inflammation through inhibition of inflammatory mediators and suppression of immune responses, making it effective for various inflammatory and autoimmune conditions in children. It's also important to note that the specific dosing regimen may vary depending on the condition being treated, and that the medication should be used under the guidance of a healthcare professional. For example, for nephrotic syndrome, higher doses of 2 mg/kg/day (maximum 60 mg) are typically used until urine is protein-free for 3 consecutive days, then tapered, as recommended by 1. In contrast, for autoimmune hepatitis, prednisone is typically administered initially in a dose of 1–2 mg/kg daily (up to 60 mg daily), as recommended by 1 and 1. However, the most recent and highest quality study 1 should be prioritized when making treatment decisions.
From the FDA Drug Label
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 recommended dose of prednisolone for pediatric patients varies depending on the specific 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 uncontrolled by inhaled corticosteroids and long-acting bronchodilators, the recommended dose is 1-2 mg/kg/day in single or divided doses 2.
From the Research
Prednisolone Dosage for Pediatric Patients
The dosage of prednisolone for pediatric patients varies depending on the condition being treated.
- For infantile spasms, a study published in 2019 3 suggests an initial dose of 8 mg/kg/day (maximum 60 mg/day) divided into three daily doses for 14 days.
- For acute childhood asthma, a study from 1998 4 recommends a dose of 0.5 mg/kg/day.
- For Bell's palsy in children, a retrospective study from 2017 5 found that a dose of 1 mg/kg/day was highly effective.
- There is limited information on the use of prednisolone for migraine headache in children, but a study from 2002 6 discusses the use of corticosteroids in the treatment of status migraine and drug-overuse headache.
- For myasthenia gravis, a study from 2008 7 recommends oral prednisolone as the first-choice short-term immunosuppressant, usually started at a low dose on an alternate-day regimen and gradually increased.