Prednisone Dosing Guidelines for Children

General Dosing Principles

The American Academy of Pediatrics and other medical societies imply that prednisone and prednisolone are equivalent medications and can be used interchangeably at the same dosage 2
For significantly overweight children, dosing should be based on ideal body weight to avoid unnecessary steroid exposure, as recommended by the American Academy of Pediatrics 1

For most conditions requiring high-dose therapy, such as nephrotic syndrome and autoimmune conditions, the initial dose is 2 mg/kg/day or 60 mg/m²/day (maximum 60 mg/day) as a single daily dose, according to the American Society of Nephrology and the American Academy of Pediatrics 3, 4, 2
For a 60 kg child, this equals 60 mg/day (the maximum dose), as stated by the American Academy of Pediatrics 1

After initial response, switch to alternate-day dosing at 1.5 mg/kg/dose or 40 mg/m²/dose (maximum 40 mg on alternate days), as recommended by the American Journal of Kidney Diseases and the National Kidney Foundation 4, 2
For a 60 kg child, this equals 40 mg every other day, according to the American Academy of Pediatrics 1
Taper gradually by reducing the dose by 5 mg every week until reaching 10 mg/day, then by 2.5 mg/week until reaching maintenance dose, as suggested by the American Association for the Study of Liver Diseases 3

Monitor for steroid-related side effects, especially with prolonged therapy, as advised by the American Academy of Pediatrics 1
Cosmetic changes occur in 80% of patients after 2 years of treatment, according to the American Association for the Study of Liver Diseases 3
Severe side effects are uncommon but more likely after prolonged therapy (>18 months), as reported by the American Association for the Study of Liver Diseases 3
Consider baseline and annual bone mineral density testing for long-term therapy, as recommended by the American Association for the Study of Liver Diseases 3
Adding steroid-sparing agents may be necessary if side effects become problematic, as suggested by the American Journal of Kidney Diseases and the National Kidney Foundation 4, 2
Combination with azathioprine may reduce corticosteroid-related side effects, according to the American Association for the Study of Liver Diseases 3