Praxis Medical Insights

Est. 2024 • Clinical Guidelines Distilled

Made possible by volunteer editors from the University of Calgary & University of Alberta

Last Updated: 10/5/2025

Corticosteroid Use in Pediatric Patients

Asthma Exacerbations

  • For acute asthma exacerbations in children, prednisone/prednisolone 1-2 mg/kg/day in 2 divided doses (maximum 60 mg/day) is recommended until peak expiratory flow reaches 70% of predicted, as suggested by the American Academy of Allergy, Asthma, and Immunology 1

Duchenne Muscular Dystrophy

  • For children ≥6 years with Duchenne muscular dystrophy, prednisone 0.75 mg/kg/day or deflazacort 0.9 mg/kg/day is recommended, with dose increases for growth up to a maximum weight of 40 kg (prednisone 30 mg/day or deflazacort 36 mg/day), according to the American Academy of Neurology 2

Nephrotic Syndrome

  • For pediatric nephrotic syndrome, prednisone 60 mg/m² or 2 mg/kg/day (maximum 60 mg/day) as a single daily dose is recommended, as per the International Study of Kidney Diseases in Children 3

Hidradenitis Suppurativa

  • For acute, widespread flares of hidradenitis suppurativa in pediatric patients, prednisone is suggested as a systemic immunomodulator, as recommended by the American Academy of Dermatology 4

Growth and Development

  • Ensure growth plates are considered when planning treatment duration, as advised by the American College of Rheumatology 5

Critical Safety Considerations

  • Screen for latent tuberculosis, ensure complete immunization schedule, and rule out latent infections before initiating corticosteroid therapy in pediatric patients, as recommended by the American Academy of Pediatrics 2
  • Monitor for corticosteroid-related adverse effects, including blood pressure, glucose intolerance, weight gain, and bone density, as suggested by the American Academy of Neurology 2

Dosing Duration and Tapering

  • For short courses (3-10 days), tapering is not necessary, especially if the patient is concurrently taking inhaled corticosteroids, as recommended by the American Academy of Allergy, Asthma, and Immunology 1
  • If stopping after long-term therapy, withdraw gradually rather than abruptly to avoid adrenal insufficiency, as advised by the American Academy of Neurology 2

REFERENCES

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