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Prednisone is a systemic corticosteroid used for pediatric inflammatory, allergic, and immune-mediated conditions requiring short tapers or chronic control.
Short bursts rarely require tapering (<7 days) unless child is on chronic steroids.
Monitor for immunosuppression—avoid live vaccines during high-dose therapy.
Track growth and blood pressure with long-term use.
Educate families on stress dosing for chronic therapy.
Consider gastrointestinal prophylaxis for prolonged high doses especially when combined with NSAIDs.
Prednisone supports a wide range of inflammatory pediatric conditions.
Core uses include asthma, nephrotic syndrome, rheumatologic disease, and allergic reactions.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Moderate to severe asthma exacerbation | Children and adolescents | Yes | Typical burst 1–2 mg/kg/day (max 60 mg) for 3–5 days without taper, initiated within the first hour of ED or clinic presentation. |
| Croup when dexamethasone unavailable | Infants and children | Yes | Prednisone/prednisolone 1 mg/kg for 2–3 days is an acceptable alternative when dexamethasone cannot be sourced. |
| Steroid-sensitive nephrotic syndrome relapse | Children | Yes | High-dose daily prednisolone followed by alternate-day taper per KDIGO pediatric nephrotic syndrome protocols. |
| Autoimmune rheumatologic flare | Children and adolescents | Yes | Short courses bridge disease-modifying therapy for conditions such as juvenile dermatomyositis or systemic lupus; specialist tailors taper. |
| Acute allergic reaction refractory to antihistamines | Children | Yes | Short burst (1–2 mg/kg/day for 2–3 days) may reduce late-phase inflammation after anaphylaxis or severe urticaria. |
| Chemotherapy-induced nausea and vomiting adjunct | Children | No | Utilized with 5-HT3 antagonists and NK1 blockers for moderately emetogenic regimens when oncology protocols require. |
FDA-approved primary uses with Level A evidence
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Quick selection guides and diagnostic pearls
When to consider other medications
How to explain treatment to families
Prednisone side effects vary with dose and duration; short bursts mostly cause appetite and mood changes.
Long-term therapy increases risk for growth suppression, hypertension, hyperglycemia, and adrenal suppression.
Hyperglycemia
Common • moderate
Adrenal suppression
Uncommon • serious
Gastritis
Common • mild
Mood changes/irritability
Common • mild
Myopathy/bone demineralization
Uncommon • serious
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Administration guidance for pediatric prednisone courses.
Give with food or milk in the morning to reduce stomach upset and mimic physiologic steroid rhythm. Use the supplied oral syringe for liquid formulations. Follow taper schedules exactly—do not stop suddenly unless instructed.
If multiple daily doses are prescribed, space evenly and take the last dose before late afternoon to limit sleep disruption. Keep a copy of the taper calendar on the fridge.
Emergency contact: Seek urgent care for breathing difficulty, swelling of the face, severe abdominal pain, vomiting bright red blood, or signs of adrenal crisis such as extreme fatigue, dizziness, or confusion.
Carry a steroid alert card for chronic use and inform all clinicians about prednisone therapy, especially before vaccines or surgery.
Different formulations and concentrations
Safe preparation and measuring techniques
Tailored approaches for different ages
Solutions for common challenges
Storage guidelines and safety tips
Expert pearls and evidence-based tips
Activated glucocorticoid receptors alter transcription of inflammatory mediators (IL-1, IL-6, TNF) and upregulate anti-inflammatory proteins, leading to broad immunosuppression.
Prednisone exerts genomic and non-genomic anti-inflammatory effects via glucocorticoid receptors.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Prednisone pearls for pediatrics.
Focus on tapering, infection precautions, and monitoring.
Give caregivers a written taper schedule and review each visit.
Advise families to avoid live vaccines and report varicella exposure immediately.
Track growth, blood pressure, and glucose in children on chronic doses.
Core insights every provider should know
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Recent updates that change how we practice
Organized by dosing, administration, and safety
How to explain treatments to families
Real-world cases with evidence-based approaches
Key numbers, algorithms, and decision tools
Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Prednisone and monitor your child's response to treatment.
Short courses do not impact growth. Long-term therapy may slow growth, so clinicians monitor regularly.
Morning dosing aligns with natural cortisol rhythms and reduces insomnia and adrenal suppression.
No. Follow the taper schedule to prevent adrenal insufficiency.
Call the clinician right away—extra protection or treatment may be needed while on steroids.