What is the appropriate methylprednisolone dose for a 1‑year‑old child (approximately 10–12 kg)?

Methylprednisolone Dosing for a 1-Year-Old Child

For a 1-year-old child (approximately 10–12 kg), the standard methylprednisolone dose is 1–2 mg/kg/day IV divided every 6 hours (10–24 mg/day total), which translates to approximately 2.5–6 mg per dose every 6 hours. 1, 2

Condition-Specific Dosing Framework

The appropriate dose depends critically on the clinical indication:

For Inflammatory Conditions (MIS-C, Severe Rashes, Autoimmune Disease)

• First-line therapy: 1–2 mg/kg/day IV (10–24 mg/day for a 10–12 kg child), typically divided every 6 hours 3, 1
• This equals approximately 2.5–6 mg per dose every 6 hours 1, 2
• For severe Grade 4 rashes requiring hospitalization, use this same dosing range 4

For Refractory or Life-Threatening Disease

• Intensification therapy: 10–30 mg/kg/day IV (100–360 mg/day for a 10–12 kg child) for persistent fevers or ongoing significant end-organ involvement 3, 1
• The American College of Rheumatology defines refractory disease as persistent fevers and/or ongoing significant end-organ involvement despite first-line therapy 3

For Acute Asthma Exacerbations

• Standard dosing: 1–2 mg/kg/day IV divided every 6 hours, with a maximum of 60–80 mg/day 1
• Continue until clinical improvement occurs, typically 3–10 days 1
• Recent evidence suggests conservative dosing (≤0.5 mg/kg/dose every 6 hours) may be equally effective with fewer side effects, though this requires further validation 5

Critical Administration Guidelines

Dosing Calculations

• Always use actual body weight for a 1-year-old, as ideal body weight calculations are only relevant for significantly overweight children 4, 1
• At this age, children are still in the "immature" category where maturation processes affect drug metabolism, making precise weight-based dosing essential 6

Route and Timing

• IV administration is preferred for initial emergency use 2
• Administer over several minutes for IV push, or over at least 30 minutes for high-dose therapy (≥30 mg/kg) 2
• Once stabilized, transition to oral prednisolone using a 4:5 ratio (methylprednisolone 1 mg = prednisolone 1.25 mg) 1

Monitoring Requirements

• Assess cardiac function and fluid status before administration, particularly important in young children 3
• Monitor for steroid-related adverse effects including vomiting (more common with higher doses), hyperglycemia, and behavioral changes 1, 7

Tapering Protocol

Short Courses (<7–10 Days)

• No tapering required – abrupt discontinuation is safe 1, 2

Prolonged Courses (>2 Weeks)

• Gradual tapering is mandatory to prevent adrenal insufficiency 4, 1
• Reduce dose by 25–33% at appropriate intervals once clinical response is achieved 4

Common Pitfalls to Avoid

• Do not underdose young children: Weight-based dosing may underdose infants compared to body surface area-based dosing, though for a 1-year-old the difference is minimal 4, 6
• Do not use evening dosing: This disrupts normal cortisol rhythm and increases hypothalamic-pituitary-adrenal axis suppression 4
• Do not restart steroids empirically for post-treatment fever: Rule out infection first, as steroids will mask fever and blunt immune response 8
• Do not assume higher doses are always better: For acute moderate asthma, 1 mg/kg/day prednisolone is non-inferior to 2 mg/kg/day with less vomiting 7