Prednisolone Dosing for a 4-Year-Old Female Weighing 37 Pounds
For a 4-year-old girl weighing 37 lb (16.8 kg), the appropriate prednisolone dose is 1–2 mg/kg/day (17–34 mg daily) given as a single morning dose, with the exact dose depending on the specific condition being treated. 1, 2, 3, 4
Weight-Based Calculation
- Patient weight: 37 lb = 16.8 kg 1
- Standard pediatric dosing range: 1–2 mg/kg/day = 17–34 mg daily for this child 1, 2, 3, 4
- Maximum daily dose: 60 mg/day for most acute conditions 1, 2, 3, 4
Condition-Specific Dosing Recommendations
Acute Asthma Exacerbations
- Dose: 1–2 mg/kg/day (17–34 mg once daily), maximum 60 mg/day 1, 2, 3
- Typical regimen: 17–34 mg once daily in the morning for 3–10 days 1, 3, 4
- No taper required for courses shorter than 7 days 1, 4
- Lower doses (1 mg/kg/day = 17 mg) are noninferior to higher doses (2 mg/kg/day = 34 mg) for moderate exacerbations, with significantly less vomiting 5
Nephrotic Syndrome (First Episode)
- Initial dose: 60 mg/m²/day or 2 mg/kg/day (34 mg once daily), maximum 60 mg/day, for 4–6 weeks 1, 2, 3
- Alternate-day phase: 40 mg/m²/day or 1.5 mg/kg/day (25 mg) on alternate days for 2–5 months with gradual tapering 1, 2, 3
- A simplified weight-based equation for 60 mg/m² is: (2 × weight in kg) + 8 = approximately 42 mg for this child 6
Autoimmune Conditions (e.g., Autoimmune Hepatitis)
- Initial dose: 1–2 mg/kg/day (17–34 mg once daily), maximum 60 mg/day, for 2 weeks 2, 3
- Maintenance taper: Reduce over 6–8 weeks to 0.1–0.2 mg/kg/day (2–3 mg daily) once remission is achieved 1, 2
Dermatologic Conditions
- Moderate disease: 0.3 mg/kg/day = 5 mg daily 1
- Moderate-severe disease: 0.5 mg/kg/day = 8 mg daily 1
- Severe disease: 0.75–1 mg/kg/day = 13–17 mg daily 1
Administration Guidelines
- Timing: Administer as a single morning dose to minimize adrenocortical suppression and mimic physiologic cortisol secretion 1, 2, 3, 4
- Exception: If behavioral side effects (hyperactivity, emotional lability) occur, consider afternoon dosing after school 1
- Divided dosing: The FDA label notes that initial doses may be given in 3–4 divided doses (4–60 mg/m²/day), though single daily dosing is preferred 4
Tapering Protocol (for Courses >10–14 Days)
- Step 1: Reduce by 5 mg every week until reaching 10 mg/day 2, 3
- Step 2: Reduce by 2.5 mg every week until reaching maintenance dose 2, 3
- Step 3: Reduce by 1 mg monthly to reach minimum effective dose 1, 2
- Important caveat: For courses <7 days (e.g., asthma exacerbations), no taper is needed 1, 4
Critical Monitoring and Safety Considerations
- Bone health: For long-term therapy (≥30 mg daily for ≥30 days), obtain baseline and annual DEXA scan of lumbar spine and hip 1, 2
- Calcium and vitamin D supplementation should be initiated immediately when starting steroid therapy 1, 2
- Growth monitoring is essential for children on long-term therapy 2, 3
- Common side effects include Cushingoid features, growth deceleration, weight gain (1.6–5 kg over months to years even at low doses), hypertension, and gastric irritation 7, 1
- HPA axis suppression is anticipated with >7.5 mg daily for >3 weeks 2
Important Clinical Caveats
- For significantly overweight children: Calculate dose based on ideal body weight rather than actual weight to avoid excessive steroid exposure 1, 2, 3
- Avoid systemic corticosteroids for bronchiolitis in children under 2 years (insufficient evidence of benefit) 2, 3
- Alternative to prednisolone: A single dose of oral dexamethasone 0.3 mg/kg is noninferior to 3 days of prednisolone 1 mg/kg/day for asthma exacerbations, with the advantage of eliminating compliance issues and reducing vomiting 8, 9