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Reference calculator for pediatric corticosteroid dosing
| Indication | Dose | Duration | Taper? |
|---|---|---|---|
| Asthma Exacerbation | 1-2 mg/kg/day (max 60mg) | 3-7 days | Usually no |
| Croup | 1-2 mg/kg (max 60mg) | 1-3 days | No |
| Allergic Reaction | 1 mg/kg/day (max 60mg) | 3-5 days | Usually no |
| Poison Ivy (severe) | 1 mg/kg/day (max 60mg) | 7-14 days | Yes if >7 days |
| Nephrotic Syndrome | 2 mg/kg/day (max 60mg) | 4-6 weeks | Yes |
| ITP | 1-2 mg/kg/day (max 80mg) | 2-4 weeks | Yes |
When taking steroids, your body's adrenal glands reduce their natural cortisol production. Stopping suddenly can leave your body without enough cortisol, causing adrenal insufficiency - potentially dangerous, especially during illness or stress.
For a 2-week high-dose course:
*Actual taper depends on duration, dose, and individual factors
Prednisone is converted to prednisolone (the active form) by the liver. For children, prednisolone liquid is often preferred because it tastes better and doesn't require liver conversion. They're essentially equivalent when the liver is functioning normally, but prednisolone may be preferred in liver disease.
Corticosteroids affect metabolism and can increase appetite significantly. They also affect brain chemistry, often causing mood changes, hyperactivity, irritability, or even euphoria. These effects are temporary and resolve when the medication is stopped. Giving the dose in the morning may help with sleep.
It depends on the dose and duration. Short courses (≤2 weeks) at typical doses usually don't affect vaccines. However, live vaccines (MMR, varicella, nasal flu spray) should generally be avoided during high-dose or long-term steroid use. Inactivated vaccines are usually safe. Always check with your doctor before vaccinating.
This is important! Steroids suppress the immune system, making chickenpox potentially more severe. If your child hasn't had chickenpox or the vaccine and is exposed while on steroids (especially long-term), contact your doctor immediately. They may recommend VZIG (varicella zoster immune globulin) or antiviral treatment.
Stopping early can cause the original condition to rebound (return worse than before). For short courses, stopping early usually isn't dangerous but may not fully treat the condition. For longer courses, stopping suddenly can cause adrenal crisis because your body's natural cortisol production is suppressed.
Most liquid prednisolone should be stored in the refrigerator and used within 90 days of opening. Refrigeration also helps improve the taste, which many children find unpleasant. Check your specific product's label for storage instructions.
Short courses typically don't affect growth. However, prolonged use (months to years) can slow growth. If your child needs long-term steroids, your doctor will monitor growth closely and use the lowest effective dose. Growth usually catches up after steroids are stopped.