Prednisolone (Paediatric)

How it works

It binds intracellular glucocorticoid receptors to modulate gene transcription, suppressing inflammatory mediators and immune cell activity.

Prescribing in practice

• Prolonged or repeated courses suppress the hypothalamic-pituitary-adrenal axis and impair linear growth in children, so the lowest effective dose for the shortest duration should be used and longer courses tapered rather than stopped abruptly.
• It increases susceptibility to infection and can mask its signs; varicella and measles exposure in a non-immune child on systemic steroids needs prompt assessment.
• Soluble and standard tablets and liquids exist; confirm the correct strength and formulation against a children's formulary.

Monitoring

For longer courses monitor growth, blood pressure, blood glucose and signs of infection, and provide steroid-sickness advice for those at risk of adrenal suppression.

Counselling the patient

• Give with or after food to reduce stomach upset.
• Do not stop a longer course suddenly; follow the reducing plan.
• Carry a steroid alert card if on prolonged treatment and seek advice if the child is exposed to chickenpox or measles.

Evidence & guidelines

Oral corticosteroids such as prednisolone are recommended in national asthma and croup guidance, and short courses are standard relapse treatment in childhood nephrotic syndrome.