Steroids in Children – Are They Always Harmful? by Dr. Sagar Bhattad

Inflammations are the body’s way of reacting to infection, bacteria, or any foreign body invasion. They happen due to the production of extra fluids by the immune system to fight a foreign invader. These inflammations can happen in any part of the body and can be very mild or severe, depending on the infection.

While steroids cannot completely cure inflammation or the health problem itself, they can effectively reduce the inflammation and bring it under control. This can help in treating the illness more effectively, with other drugs. Doctors prescribe steroids, not to cure but to ease the symptoms of a particular health issue.

Anabolic Steroids

There is another group of steroids known as anabolic steroids – which is commonly used by bodybuilders and athletes to help with their performances. These are man-made hormones again but testosterone in particular. These are used to improve performance and are more commonly known as performance enhancement drugs.

Some doctors do indeed prescribe anabolic steroids to help with issues with testosterone production in the body. But more often than not, many people misuse these steroids to improve their athletic performance.

The wide use of this drug is the reason people fear the word steroids and have a negative association with it. This form of steroid, when misused, causes a lot of health problems and can also be fatal in some cases.

Our discussion here is not about anabolic steroids. Let’s delve deeper into the safer form of steroids that help treat various health conditions in kids.

When Are Steroids Prescribed For Children?

Children suffer from many conditions, which if left untreated effectively, can have a lasting impact on their health. Sometimes, it can even compromise the quality of their lives. Some of the common conditions in children treated with Prednisone and other similar forms of steroids are

1. Allergies
2. Asthma
3. Croup
4. Juvenile Rheumatoid Arthritis/Juvenile Idiopathic Arthritis
5. Acute Demyelinating Encephalomyelitis (ADEM)
6. Leukemia
7. Congenital Adrenal Hyperplasia
8. Nephrotic Syndrome
9. Adrenocortical Insufficiency
10. Poison Ivy

Steroids form the most important part of the treatment in children with autoimmune conditions such as Juvenile Idiopathic Arthritis, SLE or Lupus, autoimmune hemolytic anemia and many others. They are in fact lifesaving in some of these children, where our immune cells are attacking self and we must stop this immediately, before irreversible damage sets in.

Types of Steroids Prescribed For Children

Steroids can be prescribed in multiple forms. Here are a few different ways and reasons for which a doctor might prescribe steroids for your child.

1. Oral

Steroids like Prednisone, betamethasone, and dexamethasone are given by mouth. They can be either tablets, liquids, or even dissolvable tablets. Doctors prescribe oral steroids to treat conditions like rheumatoid arthritis, gout, or lupus which can cause inflammation throughout the body.

2. Injection

Steroids like methylprednisolone, hydrocortisone, and triamcinolone are given in the form of injections. Doctors prescribe such steroid injections when they want to reduce inflammation at a particular site. If a health condition is causing severe inflammation in a particular area of the body, the steroid is injected into that site, to reduce the inflammation quickly. For eg: steroids can be injected into swollen joints in case of rheumatoid arthritis.

3. Eye Drops

Yes, steroids can be given through the eye too. Doctors can prescribe steroid eye ointments or drops to reduce inflammation in the eyes. Uveitis is one such condition where your doctor can prescribe prednisolone as eye drops.

4. Topical

Steroids such as hydrocortisone, mometasone, betamethasone, and clobetasol are given in the form of ointments or creams that can be applied to the skin. These steroids activate the natural substances in the skin to effectively reduce swelling, redness, or inflammations. Doctors will prescribe such creams to help with psoriasis, atopic dermatitis, and other autoimmune skin conditions.

The use of steroids cannot cure or control these health conditions indefinitely. However, they can help alleviate the pain and the swelling. In situations where a medical condition is severely impacting the quality of life of a child, steroids can be of immense help and are indeed lifesaving!

Are Steroids Safe For Children?

Let’s address the elephant in the room – are these steroids safe for your child? Do they really help them, or do they harm them in the long run?

The answer is yes if they are administered by a well-experienced medical professional who has enough expertise in treatments involving steroids. These doctors are equipped with enough knowledge and experience to understand if and when the treatment is having an adverse effect on the child, instead of helping them.

As long as you stick to the dose your doctor recommends and the use is short-term, your child may not have any long-lasting impact of the steroids.

[Read : Chickenpox in Children]

When Are Steroids in Children Not Safe?

Here are a few instances when steroids including prednisone can be unsafe for your child.

1. Chicken Pox

If your child is suffering from chickenpox, steroids must be stopped. The impact of chickenpox on a child on steroids will be much more than on a child who is not. Even if your child is in close contact with a child who has developed chickenpox, you may have to discontinue steroids, until you know your child has not contracted it too.

2. Heart Problems

If your child has a chronic heart problem, the doctor may not prescribe prednisone. Seizures and high blood pressure are also some instances where your doctor will want to avoid steroids as much as possible.

3. Long Term

It is not safe to use prednisone or any other form of steroids for a long period of time. Your doctor will discontinue the steroids after the symptoms subside. If, however, you don’t notice this happening, ask your doctor. Find out how much longer they plan to continue your child on steroids and if it is indeed safe.

Side Effects of Steroids in Children

Unfortunately, steroids, including prednisone, can cause some side effects in children. Some of the common side effects that can resolve within a few weeks of discontinuing the steroid treatment are

• Fatigue
• Weak muscles
• Acne and excess hair growth over face
• Facial puffiness
• Fragile skin
• Difficulty sleeping
• Irritability and mood swings
• Vomiting, nausea or stomach issues
• Headaches

Serious Side Effects of Steroids in Children

While the above-mentioned side effects are mild and do not need any strong medications to resolve them, there are some other serious side effects. These can have long-lasting and sometimes even damaging effects on the patient.
Some of the possible serious side effects of continuous use of Prednisone and other such steroids are

• High blood pressure or a change in blood pressure that will require regular monitoring
• Fluctuations in the glucose levels that might require insulin injections or other oral medications for diabetes. Some children might suffer from elevated levels of glucose for some time, even after prednisone is discontinued
• Fragile bones that can cause fractures or osteoporosis
• Cushing syndrome
• Cataracts in the eyes
• Glaucoma
• Vertigo
• Peptic ulcers
• Alkalosis
• Psychoses
• Seizures
• Pseudotumour Cerebri

Note: Pseudotumour Cerebri  is a condition where the pressure in the brain increases, causing tumors

These serious side effects get worse only with long-term use of prednisone. If steroids are prescribed in mild doses for a short term to treat conditions like asthma or poison ivy, the child will mostly not suffer from any side effects.

Interference of Steroids With Other Drugs in Children

If your child is on other medications like blood thinners, chemotherapy, or non-steroidal anti-inflammatories or if your child is undergoing any hormonal therapies to help with their development, the doctor will adjust the dosage of prednisone or other medications accordingly.

Just ensure your child’s doctor is fully aware of your child’s medical history, current treatments, medications, and side effects to other drugs if any.

How to Cope With Side Effects of Steroids in Children?

The general approach to severe side effects of steroids is to adjust the dosage. The doctor will try to reduce the dose of prednisone. They might try to prescribe other supportive medicines to reduce the side effects or help with the treatment. If all fails, they might change the steroid to see how the body copes with it.

1. Mood

Look out for mood swings or changes in behavior. If you are giving steroids to your toddler or young child and you do notice they are having more tantrums than usual or are more irritable, inform your doctor. The doctor may alter the dosage if feasible or will offer some advice and tips to handle the child.

2. Appetite

Your child might feel hungrier than usual and keep eating more than their usual quantity. While this can be a welcome change for some parents with fussy eaters, it is not always good news. It can lead to abnormal weight gain, which in turn can lead to other problems in the future. Ensure that your child’s diet consists of nutritious foods spread over small frequent meals, to avoid binging mindlessly on food.

3. Weight Gain

Long-term steroid usage can lead to weight gain. Check your child’s weight regularly if they are on steroids for a prolonged period of time. If they are gaining weight, check with your doctor. Dosage or variety of steroids can be changed if feasible. The doctor might also give you an alternate option.

4. Infections

Since immunity will be weak, the child is more prone to infections. Ensure the child is kept safe from infections around them. If they were to contract an infection, get medical assistance immediately.

It sure can be tricky and difficult to handle the side effects of steroids, be it small or big. Especially if it involves a young child, the entire episode can be traumatic for both the child and the family.

As adults, it is up to you to be cautious, patient, and proactive. You must keep monitoring your child and the progress of the treatment. If your child is having behavioural issues, it makes everything more challenging. Try to handle it with care and patience. Remember, the child is in a lot of pain, stress, and fear. They are not sure about what is happening to them and this is something too big for a child to handle responsibly.

[Read : 10 Most Important Nutrients Needed For Strong Immune System in Kids]

Precautions to Take While Giving Prednisone to Children

Prednisone is not a rare form of steroid for children. However, a lot of care needs to be taken when a child is put on prednisone. Here are a few precautions related to various aspects, to take when prescribing Prednisone to a child:

• If your child is experiencing side effects of the steroids prescribed to them, be sure to inform the doctor about it immediately.
• In case your child has any health conditions like diabetes, blood pressure issues, or heart-related problems, the doctor will have to monitor your child closely, to ensure the steroids are not worsening the pre-existing medical condition.
• If your child has any open wounds, they cannot continue with topical steroid creams or ointments. Skin conditions like rosacea, acne, or ulcers can get worse with steroid creams.
• In case your child wears contact lenses, they will be asked to avoid using them if steroid eye drops are given. They will have to wear spectacles to help with their vision instead of lenses.
• If your child suffers from systemic sclerosis, prednisone can cause issues with the kidney. So, an alternate form of steroid or other steroid-sparing medications might be prescribed.

1. Check-Ups

Take your child regularly to check their blood pressure, sugar, weight, and other basic parameters. The doctor or nurse will run these tests and advise you on the frequency. Don’t miss out on these tests, they are very crucial to ensure your child is safe while on steroids.

2. Dosage

Always give only the recommended dosage at the same time every day. If you miss a dose, do not rush to give it together with the next dose. It will not help but only harm the child. Also, if your child vomits after consuming oral steroids, do not give another dose without consulting the doctor first.

3. Vaccinations

Children on steroid treatments should not take live vaccines. Ensure your doctor is aware of this and suggests appropriate vaccines. Stay up to date on your child’s immunizations to avoid missing out on any. When on steroids, their immunity will be weak. Hence, it is important that they have enough protection against other diseases.

4. Tapering

When your child’s steroid treatment comes to an end, the doctor will taper down the dosage gradually. Stopping them abruptly can be dangerous. The body must be eased out of the dependency on steroids. Never self-medicate and strictly follow your doctor’s advice.

5. Medicine Storage

If you are administering oral steroids or steroid injections at home, always store the medication at room temperature or as per instructions on the package. Get all instructions from the doctor or nurse and follow them properly. Wrong storage of medicine might not only reduce its effectiveness but might also become dangerous for your child.

6. Feedback

On top of all the precautions listed above, it is important to pay attention to the feedback given by your child. If your child is too young to express themselves with words, they will do so in other forms. If at any time you realize your child is not comfortable or is having adverse reactions to steroids, do not ignore them.

Even if you are convinced that the discomfort your child is experiencing is a common side effect, convey it to the doctor. The doctor needs to know how your child is reacting to the treatment. Only then can they adjust the dosage or other medications as per requirement.

Steroids are not the first form of medication a doctor would prescribe for a child. They help in controlling and reducing symptoms in certain conditions before further treatment. When steroids are prescribed by a doctor for reasons well-explained, your child will benefit from them.

“Remember – Every medicine has good effects and bad effects (side-effects). There is no medicine, which has ONLY good effects.”  Close monitoring of your child for side effects, the medicine dosage, and the effect it has on the health condition can help prevent complications with steroids. When you are guided by a well-qualified doctor, trust them and believe in the process.

Read Also: Ibuprofen And Paracetamol For Your Children – Good Or Bad?