What is the recommended dosage of Dexamethasone (Decadron) in pediatric patients?

From the Guidelines

Dexamethasone dosing in kids should be limited to the lowest effective dose, with a recommended dose of 0.2 mg/kg per day for conditions such as bronchopulmonary dysplasia, to minimize the risk of adverse neurodevelopmental outcomes 1. When considering the use of dexamethasone in children, it is essential to weigh the potential benefits against the risks of adverse effects, particularly on neurodevelopmental outcomes.

• The American Academy of Pediatrics recommends against the use of high daily doses of dexamethasone (approximately 0.5 mg/kg per day) due to the association with numerous short- and long-term adverse outcomes, including neurodevelopmental impairment 1.
• Low-dose dexamethasone therapy (0.2 mg/kg per day) may facilitate extubation and decrease the incidence of short- and long-term adverse effects observed with higher doses of dexamethasone 1.
• For conditions such as immune thrombocytopenia, a dose of 0.6 mg/kg per day (maximum, 40 mg per day for 4 days) may be considered, but the potential benefits and risks should be carefully evaluated 1. It is crucial to note that the treatment duration should be kept as short as possible to minimize side effects, and parents should be aware of potential side effects, including increased appetite, mood changes, sleep disturbances, and susceptibility to infections.
• The medication should be administered exactly as prescribed, and not stopped abruptly, to ensure the best possible outcomes for the child.
• Further studies are needed to fully understand the effects of dexamethasone on children and to determine the optimal dosing regimens for various conditions 1.

From the Research

Dexamethasone Dosage in Kids

• The dosage of dexamethasone in kids can vary depending on the condition being treated and the age and weight of the child.
• A study published in the Journal of Clinical Pharmacology 2 found that a single dose of 0.5 or 1 mg/kg of dexamethasone resulted in comparable exposures to adult estimates in children with obesity.
• Another study published in Current Opinion in Pediatrics 3 discussed the use of dexamethasone in the treatment of various pediatric conditions, including anaphylaxis, croup, and asthma, but did not provide specific dosage recommendations.
• A study published in The Journal of Pediatric Pharmacology and Therapeutics 4 compared the efficacy of a standardized dose of dexamethasone with a weight-based approach in pediatric asthma exacerbations and found no difference in return visits to the emergency department.
• A study published in Pediatric Emergency Care 5 found that a single dose of oral dexamethasone (0.6 mg/kg to a maximum of 18 mg) was as effective as 5 days of twice-daily prednisolone in the management of mild to moderate asthma exacerbations in children.

Conditions Treated with Dexamethasone

• Dexamethasone is used to treat various conditions in children, including:
  • Asthma exacerbations 4, 5
  • Anaphylaxis 3
  • Croup 3
  • Retinopathy of prematurity 6
  • Multisystem inflammatory syndrome in children 3
  • Coronavirus disease 3

Administration and Dosage

• Dexamethasone can be administered orally or intravenously 2.
• The dosage of dexamethasone can vary depending on the condition being treated and the age and weight of the child, but common dosages include:
  • 0.5 or 1 mg/kg for asthma exacerbations 2
  • 0.6 mg/kg to a maximum of 18 mg for mild to moderate asthma exacerbations 5
  • 1 mg/ml for retinopathy of prematurity 6