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Adverse Events Following Short-Course Systemic Corticosteroids Among Children and Adolescents: A Systematic Review
João Pedro Lima1,2, Saifur R Chowdhury1,3, Wimonchat Tangamornsuksan1
1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
JAMA Network Open
|September 30, 2025
Summary
Short-term systemic corticosteroids in children are linked to increased risks of hyperglycemia and sleep problems, with low certainty for gastrointestinal bleeding. Serious adverse events were rare, suggesting a need for individualized treatment approaches.
Area of Science:
- Pediatric Pharmacology
- Clinical Therapeutics
- Evidence-Based Medicine
Background:
- Short courses of systemic corticosteroids are frequently used for acute pediatric conditions like Bell palsy, croup, and pneumonia.
- However, comprehensive data on associated adverse events (AEs) in children and adolescents is limited.
Purpose of the Study:
- To systematically document AEs linked to short-term (≤14 days) systemic corticosteroid use in pediatric populations (ages 1 to <18 years).
- To evaluate AEs across various clinical conditions treated with short-course systemic corticosteroids.
Main Methods:
- A systematic review and meta-analysis of randomized clinical trials was conducted, searching MEDLINE, Embase, and CENTRAL databases up to February 2025.
- Data extraction and risk of bias assessment were performed by independent reviewers following PRISMA guidelines.
- Pairwise, fixed-effects meta-analyses using Mantel-Haenszel methods calculated risk differences (RD) for primary outcomes.
Main Results:
- Analysis of 45 trials (6470 children) showed moderate certainty evidence that corticosteroids were not associated with serious AEs, discontinuation-related AEs, or behavioral changes.
- Moderate certainty evidence indicated an increased risk of hyperglycemia (RD, 38/1000) and sleep problems (RD, 15/1000) with corticosteroid use.
- Low certainty evidence suggested an increased risk of gastrointestinal bleeding (RD, 13/1000), though these events were rarely serious.
Conclusions:
- Short-term systemic corticosteroid use in children is associated with a higher incidence of hyperglycemia and sleep disturbances, with a less certain increased risk of gastrointestinal bleeding.
- These adverse events are generally not serious, supporting an individualized approach to prescribing short-course corticosteroids in pediatric patients.
- Further research is recommended to enhance the quality of evidence regarding corticosteroid-associated AEs in children.
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