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Multiple short courses of corticosteroids in children
Tristan Harding1, Anton Harding2
1BSc, MSc, MD, Paediatric Registrar, The Royal Children@s Hospital, Vic.
Insights
Short courses of oral corticosteroids are safe for children. Longer steroid use requires specialist management to prevent adrenal insufficiency and other side effects.
Area of Science:
- Pediatric Endocrinology
- Pharmacology
- Immunology
Background:
- Corticosteroids are vital adrenal hormones regulating immune homeostasis, blood pressure, and metabolism.
- Oral corticosteroids are frequently prescribed for pediatric conditions like asthma and inflammatory bowel disease.
- Concerns exist regarding potential side effects of steroid use, including growth reduction, weight gain, behavioral changes, and immunosuppression.
Purpose of the Study:
- To provide an overview of oral corticosteroid use in common pediatric conditions.
- To highlight current management strategies for pediatric steroid use.
- To discuss the risks associated with recurrent corticosteroid dosing in children.
Main Methods:
- Literature review of studies on pediatric corticosteroid use.
- Analysis of current clinical guidelines and management practices.
- Synthesis of data on short-term and long-term side effects.
Main Results:
- Short-term oral corticosteroid courses (under two weeks) are unlikely to cause long-term adverse effects in children.
- Prolonged corticosteroid therapy necessitates specialist referral and a carefully managed weaning plan.
- Recurrent steroid courses may increase the risk of adrenal suppression and insufficiency.
Conclusions:
- Judicious use of short-term corticosteroids is generally safe in pediatric populations.
- Extended corticosteroid treatment requires vigilant monitoring and specialist input to mitigate risks.
- Effective management strategies are crucial for minimizing adverse outcomes in children on long-term steroids.
Background:
Corticosteroids are adrenal steroid hormones responsible for immune homeostasis, blood pressure regulation, energy and appetite regulation, and suppression of inflammation. Oral corticosteroids ('steroids') are commonly used in children for a number of medical conditions, including asthma, croup, inflammatory bowel disease and nephrotic syndrome. There has been some concern about potential side effects of oral, topical or inhaled steroids, including reduction in growth, weight gain, behavioural changes and immunosuppression resulting in infection.
Objective:
While many recent studies have assessed individual risks, this article aims to provide an overview of steroid use in common paediatric presentations, highlighting current management and risks associated with recurrent doses of steroids in the paediatric population.
Discussion:
Short courses of oral steroids (less than two weeks) in children are very unlikely to cause long-term side effects in children. Children requiring courses more than two weeks' duration warrant specialist referral and a weaning plan to reduce adrenal suppression and insufficiency.
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