What is the appropriate prednisolone dosing for a 22‑month‑old child weighing 10.94 kg?

Prednisolone Dosing for a 22-Month-Old Child Weighing 10.94 kg

For this 22-month-old child weighing 10.94 kg, administer prednisolone at 1–2 mg/kg/day (approximately 11–22 mg daily) as a single morning dose, with the specific dose and duration determined by the underlying condition being treated. 1, 2, 3

Weight-Based Dosing Framework

The standard pediatric prednisolone dosing range is 1–2 mg/kg/day, which translates to:

• Low-dose therapy (0.3 mg/kg/day): ~3 mg daily for moderate conditions 2
• Moderate therapy (0.5 mg/kg/day): ~5.5 mg daily for moderate-severe disease 2
• High-dose therapy (1–2 mg/kg/day): 11–22 mg daily for acute/severe conditions 1, 2, 3
• Maximum ceiling: 60 mg/day regardless of calculated dose 2, 4, 3

Condition-Specific Dosing Recommendations

Acute Asthma Exacerbations

• Dose: 1–2 mg/kg/day (11–22 mg once daily), typically 20 mg daily for practical dosing 1, 5, 3
• Duration: 3–10 days, with 3–5 days often sufficient for URI-triggered exacerbations 5, 3
• No taper required for courses under 7–10 days 1, 2, 5
• Must be combined with bronchodilator therapy (salbutamol 2.5 mg nebulized every 4–6 hours initially) 5

Nephrotic Syndrome (First Episode)

• Induction phase: 2 mg/kg/day (~22 mg daily) as a single morning dose for 4–6 weeks 2, 4, 3
• Alternate-day phase: 1.5 mg/kg/day (~16 mg) on alternate days for 2–5 months, followed by gradual taper 2, 4
• Minimum total duration: At least 12 weeks to achieve sustained remission 2

Autoimmune Conditions

• Initial dose: 1–2 mg/kg/day (11–22 mg daily) for 2 weeks 2
• Taper: Reduce over 6–8 weeks to maintenance of 0.1–0.2 mg/kg/day (1–2 mg daily) 2, 4

Critical Administration Guidelines

Timing is essential: Administer as a single morning dose before 9 AM to minimize hypothalamic-pituitary-adrenal (HPA) axis suppression and mimic physiologic cortisol secretion patterns. 2, 4, 3 This approach reduces adrenal suppression compared to divided dosing while maintaining equivalent efficacy. 6

Practical formulation: Using prednisolone 15 mg/5 mL oral solution:

• For 11 mg dose: 3.7 mL once daily
• For 20 mg dose: 6.7 mL once daily
• For 22 mg dose: 7.3 mL once daily 4

Tapering Protocol

Short courses (≤7–10 days): No taper necessary; stop abruptly after completion. 1, 2, 5 This applies to typical asthma exacerbations and brief rescue courses.

Longer courses (>10–14 days): Implement structured taper to avoid adrenal insufficiency:

• Reduce by 25–33% at appropriate intervals until reaching 10 mg/day 2, 4
• Then decrease by smaller increments (1 mg monthly) to reach minimum effective dose 2
• Never stop abruptly after prolonged therapy due to risk of adrenal crisis 2

Essential Monitoring and Prevention

Bone Health Protection

Initiate immediately when starting therapy:

• Calcium supplementation 2, 4
• Vitamin D supplementation 2, 4
• These measures are critical even for short courses to protect developing bone in pediatric patients 7

Common Side Effects to Monitor

• Cushingoid features (moon facies, central obesity) 2, 4
• Growth deceleration (particularly concerning in toddlers) 2, 4
• Weight gain and increased appetite 2, 4
• Hypertension 2
• Behavioral changes (hyperactivity, emotional lability) 4

HPA Axis Suppression Risk

• Doses >5 mg/day increase likelihood of adrenal suppression 2
• For therapy anticipated to last >2–3 weeks, expect HPA axis suppression and plan accordingly 2
• Provide stress-dose steroids during intercurrent illness if child has received prolonged therapy 2

Critical Clinical Pitfalls

Avoid dosing errors in overweight children: If this child were significantly overweight for age, calculate dose based on ideal body weight rather than actual weight to prevent excessive steroid exposure. 2, 4 However, at 10.94 kg for 22 months, this child is at an appropriate weight.

Ensure immediate administration: For acute conditions like asthma exacerbations, give the first dose immediately upon recognition of need for systemic steroids—do not delay. 5

Reassess within 48 hours: For outpatient management, schedule follow-up within 2 days to ensure objective improvement and adjust therapy if needed. 5

Hospital referral indications: Transfer immediately if the child shows failure to respond to initial therapy, severe breathlessness, life-threatening features, or if parents cannot reliably administer treatment at home. 5