Prednisone and Other Steroids for Kids

Boy with chicken pox

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In This Article

Prednisone, an oral corticosteroid pill available by prescription, has a wide range of uses in children. Because of its potent anti-inflammatory and immune-suppressing effects, it is used to treat common conditions such as asthma, allergies, and croup, as well as juvenile rheumatoid arthritis (JRA), acute demyelinating encephalomyelitis (ADEM), and others.

Prednisone does not work immediately because it affects immune cell production through the regulation of cellular DNA. But given its effectiveness, it is frequently the treatment of choice for these and other conditions.

While beneficial in many regards, use of predinsone by children and adolescents must be considered carefully because of associated risks to development and other concerns.

Uses

A number of different chronic and acute childhood conditions are treated with prednisone.

For children, prednisone is most commonly prescribed to treat:

Medical illnesses such as lupus that can be precipitated by the body's own overactive immune response may also improve with prednisone treatment. Prednisone is also used to treat children who are diagnosed with juvenile rheumatoid arthritis (JRA), leukemia, congenital adrenal hyperplasia, adrenocortical insufficiency, and nephrotic syndrome.

In some circumstances, prednisone is also part of the treatment strategy for childhood cancer or severe infections.

Often, prednisone is used along with another medication, such as an antibiotic (for infection), hormone therapy (for an endocrine problem), or chemotherapy (for cancer).

It is also indicated for endocrine, collagen, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplastic, edematous, gastrointestinal, and nervous system disorders—especially when inflammation is believed to be a major part of the disease.

Sometimes, if a child has experienced a severe traumatic injury with resulting edema (tissue swelling), prednisone may be used to reduce the swelling, especially if it is affecting the brain or spine.

Before Taking

Prednisone is an important medication that can treat a number of childhood illnesses, but there are important precautions to be aware of when it is used in children and adolescents.

Precautions and Contraindications

This medication inhibits the body's natural immune system and can worsen infections.

It also has an effect on hormones, sometimes causing pituitary-adrenal axis suppression. Long-term use of prednisone can disrupt a child's growth.

If your child has diabetes, prednisone must be used with caution.

Infections

While prednisone is sometimes used to treat excessive inflammation due to a severe infection, it suppresses the immune system and can also exacerbate an already existing infection. Your child's medical team will use prednisone cautiously if your child has an infection.

However, sometimes an infection might not be apparent when prednisone is started, or it can develop while your child is taking the medication.

Vaccination Status

Children who have not been vaccinated are especially susceptible to infections such as measles or chickenpox, and these infections can be more severe and dangerous than usual when a child is taking prednisone.

Your child may be more susceptible to infection if they receive a live vaccine (i.e., one made from weakened infectious organisms) while using prednisone.

Growth

Children and adolescents may experience altered growth, sexual maturation, and bone development when taking prednisone. These effects may have long-term implications even after the medication is stopped.

Diabetes

If your child has been diagnosed with diabetes, prednisone may disrupt their glucose management. Your child will likely need closer monitoring of blood glucose and possibly an adjustment of insulin dose.

Other Corticosteroids

Corticosteroid medications are synthetically produced versions of the steroids made by the adrenal glands. In addition to prednisone, other corticosteroid medications can be taken by children as well and may be considered.

  • Younger children who can't swallow pills are usually prescribed prednisolone as Prelone or Orapred.
  • A Medrol Pak is a form of methylprednisolone, a similar, although different corticosteroid.
  • Children who need an injectable or IV form of steroid may receive methylprednisolone as Depo-Medrol or Solu-Medrol.
  • Dexamethasone is another type of steroid shot that is more potent and longer-acting, which is also sometimes given to children.

There is often confusion between prednisone and the anabolic steroids abused by some athletes bodybuilders. While prednisone is a steroid, it does not have the same muscle-building effects as anabolic steroids.

Dosage

Prednisone is a generic medication. RAYOS is a delayed-release prednisone tablet that is available in 1 milligram (mg), 2 mg, and 5 mg doses.

The recommended dose for children can vary widely, ranging from less than 1 mg to 60 mg or more per day, depending on the condition being treated.

Your child's doctor will prescribe the lowest dose that has a clinical effect in order to avoid adverse events.

Tapering

Long-term courses of prednisone are usually slowly tapered because abruptly stopping the medication can cause issues with blood pressure and/or blood glucose.

Your child's doctor may give you a schedule to reduce the medication. Typically, this tapering dose is not expected to be therapeutic.

How to Take and Store

Prednisone should be taken with food. It should be stored its original container at room temperature, away from light and moisture.

This drug should not be crushed, split, or chewed, as it may increase the risk fo side effects.

Side Effects

Prednisone can produce a number of side effects in children. While some may be relatively minor, others are of significant concern.

Common

Some of the more common side effects of prednisone may resolve within a few weeks after the medication is stopped.

Common side effects include:

  • Acne
  • Skin fragility
  • Headaches
  • Fatigue
  • Muscle weakness
  • Edema of the extremities
  • Hypokalemia (low potassium levels): Your child's blood potassium level may need to be monitored.
  • Stomach upset, nausea, and vomiting
  • Mood swings, irritability
  • Difficulty sleeping

Severe

Some of the side effects of prednisone can have a serious and long-term impact on children and adolescents. They may experience:

  • Changes in blood pressure, especially high blood pressure
  • Elevated glucose, sometimes necessitating treatment with insulin or other medications used for diabetes: In some instances, a child may continue to have problems regulating blood sugar long after prednisone is discontinued.
  • Bone fragility (bone fracture, osteoporosis)
  • Cushing syndrome
  • Alkalosis
  • Cataracts
  • Glaucoma
  • Peptic ulcer
  • Vertigo
  • Seizures
  • Psychoses
  • Pseudotumor cerebri

Most side effects, especially hormonal and immune system problems, are worse with long-term use of prednisone and less likely with the short course that most children take issues such as typical asthma attacks or poison ivy.

Interactions

Prednisone can interact with many medications, including blood thinners, chemotherapeutic therapies, and nonsteroidal anti-inflammatories (NSAIDs). It can also interact with hormonal therapies, such as those prescribed for developmental childhood conditions.

Your child's doctor will adjust the prednisone dose and the dose of other medications to account for these interactions.

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