Prednisone for Kids

Prednisone is a prescription oral corticosteroid pill with potent anti-inflammatory and immune-suppressing effects. It's an effective treatment used to improve a wide range of conditions in children, such as asthma, allergies, and juvenile rheumatoid arthritis (JRA). However, its use must be considered carefully because of associated risks to development and other concerns.

This article discusses childhood conditions treated with prednisone, what you should know before having your child take it, and potential side effects of the medication.

Uses

A number of different chronic and acute childhood conditions are treated with prednisone. For children, prednisone is most commonly prescribed to treat:

• Asthma attacks
• Croup
• Poison ivy
• Allergic reactions

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
• Nephrotic syndrome

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

It is also indicated for diseases that involve inflammation and are:

• Endocrine
• Collagen
• Dermatologic
• Allergic
• Ophthalmic
• Respiratory
• Hematologic
• Neoplastic
• Edematous
• Gastrointestinal
• Nervous system

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 effective 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.

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 Dosepak 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.

Anabolic Steroids

There is often confusion between prednisone and the anabolic steroids abused by some athletes and 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 in 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 for 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 and 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

Interactions

Prednisone can interact with many medications, including:

• Blood thinners
• Chemotherapy
• 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.

Summary

Prednisone is a powerful corticosteroid medication that can effectively treat a range of childhood illnesses, from croup and allergies to arthritis and cancer. It should be used cautiously, however, due to its potential for side effects. While some of these are relatively minor, prednisone can also cause severe effects such as seizures and bone fractures.

Before getting a prescription for prednisone for your child, it's best to speak to a healthcare provider about benefits and risks of the drugs, as well as precautions to take before your child takes it.