Prednisolone Dosing in Children

General Dosing Principles

The American Academy of Pediatrics recommends body surface area dosing (mg/m²) over weight-based dosing (mg/kg) because it better parallels prednisolone metabolism and reduces the risk of underdosing in younger children 1
The American Academy of Pediatrics suggests always using ideal body weight rather than actual weight in significantly overweight children to avoid unnecessary steroid exposure and increased side effects 1, 3, 2
The maximum daily dose is typically 60 mg, though up to 80 mg may be considered for specific severe conditions 1
Administer prednisolone as a single morning dose before 9 AM to align with physiologic cortisol rhythm and minimize hypothalamic-pituitary-adrenal axis suppression 1, 2
The American College of Clinical Pharmacy states that prednisolone and prednisone are equivalent and interchangeable at the same dosage 4, 1, 3

For acute asthma exacerbations, the American Thoracic Society recommends a dose of 1-2 mg/kg/day (maximum 60 mg/day) as a single daily dose for 3-10 days 1, 3, 2
For nephrotic syndrome (initial episode), the American Society of Nephrology recommends an initial phase of 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) as a single morning dose for 4-6 weeks 4, 1, 2
For nephrotic syndrome (relapses), the American Society of Nephrology suggests infrequent relapses: 60 mg/m² or 2 mg/kg (maximum 60 mg/day) until remission for at least 3 days, then 40 mg/m² or 1.5 mg/kg on alternate days for at least 4 weeks 4
For autoimmune hepatitis, the American Association for the Study of Liver Diseases recommends an initial dose of 1-2 mg/kg/day (maximum 60 mg/day) for two weeks, either alone or with azathioprine 5, 1, 3, 2

The American Academy of Pediatrics recommends gradual tapering for courses longer than 2 weeks to prevent adrenal insufficiency 1
Reduce the dose by 25-33% at appropriate intervals once clinical response is achieved 1, 3
When tapering from higher doses, reduce by 5 mg every week until 10 mg/day is achieved, then reduce by 2.5 mg/week down to 5 mg daily 5, 2

The American Academy of Pediatrics recommends monitoring growth parameters, blood pressure, and Cushingoid features regularly 1, 2
The American Association for the Study of Liver Diseases suggests baseline and annual bone mineral densitometry of lumbar spine and hip for patients on long-term corticosteroid treatment 5, 2
Calcium and vitamin D supplementation should be provided during therapy 3, 2

The American Association for the Study of Liver Diseases states that cosmetic changes occur in 80% of patients after 2 years of corticosteroid treatment regardless of regimen 5
For children with behavioral side effects, consider afternoon dosing after school instead of morning administration 3
The American Academy of Pediatrics recommends avoiding systemic corticosteroids for bronchiolitis in infants under 2 years due to insufficient evidence of benefit 2