At what age can prednisone tablets be initiated in children?

Age to Start Prednisone Tablets in Children

Prednisone tablets can be initiated at any age in children for appropriate indications, with no absolute minimum age restriction, though the specific starting age depends on the underlying condition being treated. 1, 2

Condition-Specific Age Guidelines

Acute Conditions (No Minimum Age)

• Asthma exacerbations: Prednisone may be started at any pediatric age at 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1, 3
• Croup: Single-dose therapy at 1 mg/kg can be given at any age, though dexamethasone is preferred 4
• Nephrotic syndrome: Standard dosing of 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) can be initiated in children under 12 years without requiring kidney biopsy first 1

Chronic Conditions (Age-Specific Restrictions)

• Duchenne Muscular Dystrophy: Do NOT start before age 4 years, with the standard initiation age being 6 years (±2 years) at 0.75 mg/kg/day 5, 1

  • Children under 2 years who are still gaining motor skills should NOT receive glucocorticoids 1
  • Defer treatment if the child is showing improvement in motor function 1

• Chronic lung disease/BPD in premature infants: Can be initiated in the neonatal period for evolving bronchopulmonary dysplasia, though timing remains controversial with concerns about neurodevelopmental outcomes 5

• Infantile hemangiomas: Prednisone at 2-3 mg/kg/day can be used as alternative therapy when propranolol cannot be used, with no specific minimum age restriction 1

Critical Pre-Treatment Requirements

Before initiating prednisone in any child, ensure the immunization schedule is complete, particularly varicella vaccination. 1, 2

Dosing Considerations by Age

General Principles

• For significantly overweight children: Dose based on ideal body weight to avoid excessive steroid exposure 1
• Maximum single dose: Should not exceed 60 mg regardless of calculated dose 6, 1
• Administration timing: Give as a single morning dose to minimize adrenocortical suppression 6

Age-Specific Dosing for Asthma

• Children 0-4 years: 1-2 mg/kg/day (maximum 30 mg/day) for 3-10 days 1
• Children 5-11 years: 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1

Monitoring Requirements (All Ages)

All pediatric patients on prednisone require close monitoring regardless of age, with growth velocity being the most sensitive indicator of systemic corticosteroid exposure. 1, 2

Essential Monitoring

• Growth velocity: Most sensitive indicator, can be affected even without HPA axis suppression 2
• Blood pressure: At each visit using age and height-specific percentiles 1
• For long-term use (>3 months):
  • Annual ophthalmological examination for cataracts 5, 1
  • Annual DEXA scans and vitamin D monitoring 1
  • Urine glucose screening and blood glucose if positive 1

Common Pitfalls to Avoid

• Do NOT use prednisone for non-specific cough in children without clear asthma features 1
• Do NOT initiate in children under 2 years with Duchenne muscular dystrophy who are still making motor progress 1
• Do NOT use for virus-induced wheezing in children under 5 years presenting to hospital 1
• Do NOT delay steroid administration in true asthma exacerbations, as underuse is associated with increased mortality 1

Tapering Considerations

• Courses under 10 days do not require tapering 1, 4
• Never stop glucocorticoids abruptly—ensure gradual taper for prolonged courses 1

Safety Profile for Short Courses

Recent meta-analysis evidence shows that short-course systemic corticosteroids (≤14 days) in children are associated with increased risk of hyperglycemia (38 more events per 1000 patients) and sleep problems (15 more events per 1000 patients), but serious adverse events are rare. 7 Behavioral side effects, particularly anxiety and aggressive behavior, are dose-dependent and occur twice as frequently at 2 mg/kg/day compared to 1 mg/kg/day. 8