Prednisolone Dosing for an 11.34 kg Child
For a child weighing 11.34 kg, administer prednisolone 11–22 mg once daily in the morning, with the specific dose and duration determined by the underlying condition being treated. 1, 2
General Weight-Based Dosing Framework
- The standard pediatric dose of prednisolone is 1–2 mg/kg/day administered as a single morning dose, which translates to 11–22 mg daily for an 11.34 kg child. 1, 3
- The absolute maximum daily dose should not exceed 60 mg/day, regardless of weight-based calculations. 1, 3
- Single morning administration before 9 AM is the evidence-based standard because it minimizes hypothalamic-pituitary-adrenal (HPA) axis suppression and mimics physiologic cortisol secretion patterns. 1, 2
Condition-Specific Dosing Recommendations
Acute Asthma Exacerbations
- Dose: 1–2 mg/kg/day (11–22 mg once daily), with a practical fixed dose of 20 mg daily for most children in this weight range. 1, 3
- Duration: 3–10 days; courses of 3–5 days are often sufficient when triggered by upper respiratory infections. 1, 3
- No taper required for courses ≤7–10 days; the medication can be stopped abruptly. 1
- Concurrent therapy: Must be combined with a short-acting bronchodilator (e.g., salbutamol nebulized every 4–6 hours initially). 1
First-Episode Nephrotic Syndrome
- Induction phase: 2 mg/kg/day (approximately 22 mg) as a single morning dose for 4–6 weeks. 1, 3
- Alternate-day phase: 1.5 mg/kg/day (approximately 17 mg) on alternate days for 2–5 months, followed by gradual taper. 1, 3
- Minimum total therapy: At least 12 weeks to achieve sustained remission. 1
Autoimmune Conditions
- Initial therapy: 1–2 mg/kg/day (11–22 mg) for 2 weeks. 1
- Taper: Reduce over 6–8 weeks to a maintenance dose of 0.1–0.2 mg/kg/day (approximately 1–2 mg daily). 1
Practical Administration Using Oral Solution
Using the standard 15 mg/5 mL prednisolone suspension 3:
| Desired Dose | Volume Required |
|---|---|
| 11 mg | 3.7 mL |
| 20 mg | 6.7 mL |
| 22 mg | 7.3 mL |
- Administer the calculated volume once daily in the morning before 9 AM. 1, 2
- Prednisolone may be given with or without food, though administration with meals may improve gastrointestinal tolerability. 4
Tapering Protocols
Short Courses (≤7–10 days)
- No taper needed; stop the medication abruptly after the prescribed duration. 1
- This applies to most acute conditions such as asthma exacerbations or viral respiratory infections. 1, 5
Longer Courses (>10–14 days)
- Reduce the dose by 25–33% at appropriate intervals until reaching 10 mg/day. 1, 2
- Then decrease by 1 mg per month until the minimum effective dose is achieved. 1
- Never discontinue abruptly after prolonged therapy to avoid adrenal crisis. 1
Monitoring and Prevention
Bone Health
- Initiate calcium and vitamin D supplementation at the start of therapy to protect developing bone, even for short courses. 1, 6
- This is particularly important in children due to their rapid skeletal growth. 1
Adverse Effects to Monitor
- Cushingoid appearance (moon facies, central obesity) 1, 2
- Growth deceleration (particularly concerning in toddlers and young children) 1, 2
- Weight gain and increased appetite 1, 2
- Hypertension 1
- Behavioral changes (hyperactivity, emotional lability) 1, 2
HPA Axis Suppression
- Doses >5 mg/day increase the risk of adrenal suppression. 1
- Courses expected to last >2–3 weeks should be assumed to suppress the HPA axis. 1
- Provide stress-dose steroids during intercurrent illness for children on prolonged therapy. 1
Critical Clinical Pitfalls to Avoid
Dosing Errors
- For overweight children: Calculate the dose based on ideal body weight rather than actual weight to avoid excess steroid exposure. 2
- Avoid divided dosing: Single morning administration is superior to multiple daily doses for minimizing adrenal suppression. 1, 2, 7
Treatment Delays
- For acute conditions: Give the first dose immediately once systemic steroids are indicated; do not delay. 1
- The anti-inflammatory effects may not be apparent for 6–12 hours, making early administration critical. 8
Inadequate Follow-Up
- Arrange a 48-hour outpatient review to assess response and adjust therapy if needed. 1
- Transfer to hospital promptly if there is failure to respond, severe respiratory distress, life-threatening features, or inability of caregivers to reliably administer medication at home. 1
Premature Discontinuation
- Do not discharge children with asthma until peak expiratory flow is >75% of predicted with <25% variability. 8
- Complete the full prescribed course even if symptoms improve rapidly. 1, 5
Evidence Quality Considerations
The dosing recommendations are derived from high-quality guidelines published in Thorax 1, FDA drug labeling 3, and consensus statements from major pediatric societies 2. Research studies demonstrate that oral prednisolone at 2 mg/kg/day effectively reduces disease severity and duration of symptoms in children with acute respiratory conditions 9, 5, with efficacy comparable to intravenous administration when gastrointestinal absorption is intact 8.