Corticosteroid — Asthma Exacerbation / Croup / Nephrotic Syndrome / IBD Pregnancy: Use with caution — corticosteroids used for fetal lung maturation (betamethasone preferred); prednisolone used in maternal conditions; neonatal adrenal suppression possible

Prednisolone (Paediatric)

Brand names: Prednesol, Deltacortril, Millipred

Adult dose

Dose: Asthma exacerbation: 40–50 mg once daily × 5 days; Inflammatory conditions: 0.5–1 mg/kg once daily

Route: Oral

Frequency: Once daily

Max: 40–60 mg/day

Adult reference — see paediatric dose section

Paediatric dose

Dose: Asthma exacerbation: 1–2 mg/kg once daily × 3–5 days (max 40 mg); Nephrotic syndrome induction: 60 mg/m² daily (max 80 mg) × 4–6 weeks then alternate-day taper; Croup (moderate-severe): single dose 1 mg/kg (max 10 mg) — or dexamethasone 0.15–0.6 mg/kg preferred mg/kg

Route: Oral (soluble tablets preferred — 5 mg soluble in most paediatric patients)

Frequency: Once daily (morning to minimise HPA suppression)

Max: 80 mg/day (nephrotic syndrome); 40 mg/day (asthma)

BNFc: soluble prednisolone tablets (5 mg) can be dispersed in water — better palatability for children; oral solution not currently available commercially in UK. Nephrotic syndrome: high-dose prolonged course — bone protection (calcium + vitamin D), PCP prophylaxis (co-trimoxazole) and varicella prophylaxis (varicella immunoglobulin if exposed) required. (or mg/m²)

Dose adjustments

Renal

No dose adjustment required; monitor fluid and electrolytes (sodium retention, hypokalaemia)

Hepatic

Use with caution — reduced conversion of prednisone to prednisolone in severe hepatic impairment

Paediatric weight-based calculator

Patient weight (kg)

Clinical pearls

Varicella warning: children on high-dose corticosteroids (>2 mg/kg/day prednisolone or >40 mg/day) who have no immunity to varicella and are exposed — give varicella zoster immunoglobulin (VZIG) within 10 days; if chickenpox develops — IV aciclovir (potentially fatal in immunosuppressed)
Adrenal suppression: courses >2 weeks with >2 mg/kg/day — taper dose; do not stop abruptly; consider steroid emergency card and Medic Alert for sick day rules
Behavioural effects in children: mood swings, aggression, insomnia — warn parents; usually resolves with dose reduction; does not contraindicate treatment in asthma/nephrotic syndrome
Growth monitoring: plot height 6-monthly in children on maintenance corticosteroids; consider bone age X-ray annually for prolonged courses

Contraindications

Systemic infection without antimicrobial cover
Live vaccines during high-dose therapy
Hypersensitivity to prednisolone

Side effects

Growth suppression (prolonged courses)
Cushing's syndrome
Adrenal suppression
Osteoporosis
Hypertension
Hyperglycaemia
Immunosuppression (varicella risk)
GI ulceration
Behavioural changes (steroid-induced mood changes — common in children)
Cataracts (prolonged)

Interactions

NSAIDs — additive GI ulceration
Live vaccines — contraindicated during high-dose therapy
CYP3A4 inducers (rifampicin, phenytoin) — reduce prednisolone levels
Antidiabetics — antagonised by prednisolone

Monitoring

Blood pressure
Blood glucose
Height and weight (growth)
Urine protein (nephrotic syndrome)
Bone density (prolonged courses)
Ophthalmology (cataracts, glaucoma)
Varicella immunity status

Reference: BNF for Children; NICE NG80 (Asthma); RCPCH Nephrotic Syndrome Guidelines; BTS/SIGN Asthma Guideline. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways