Steroid Use in Pediatric Respiratory Viral Infections

Clinical Context Determines Steroid Use

The American Academy of Allergy, Asthma, and Immunology recommends that systemic corticosteroids should be considered for children with viral respiratory infections only when there is moderate-to-severe asthma exacerbation or a history of severe virus-triggered exacerbations 1
The American Academy of Pediatrics suggests that low-dose inhaled corticosteroids should be started as first-line controller therapy for children with recurrent wheezing and evidence of atopic disease 2

The American College of Rheumatology recommends that methylprednisolone (1-2 mg/kg/day IV) combined with IVIG (2 gm/kg) is first-line treatment for multisystem inflammatory syndrome in children (MIS-C) 3
The American College of Rheumatology suggests that children with severe COVID-19 and hyperinflammation should be considered for glucocorticoid therapy, though evidence is limited in pediatrics 4

The National Asthma Education and Prevention Program recommends that proper inhaler technique with spacer devices should be ensured, especially for inhaled corticosteroids 1, 5
The European Respiratory Society suggests that growth should be monitored in children on inhaled corticosteroids >400 µg/day, though short-term reductions in growth rate cannot be extrapolated long-term 5