Recommendations for minimising and monitoring adverse effects of long-term supraphysiological corticosteroid use in children and young persons.

Abstract

To cite: Micallef C, Chana S. Arch Dis Child Educ Pract Ed Epub ahead of print: [please include Day Month Year]. doi:10.1136/archdischild2023325402 © Author(s) (or their employer(s)) 2023. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION The mother of a 4yearold boy with a history of nephrotic syndrome presents to the Paediatric Assessment Unit in view of three consecutive urine dip stick tests positive for protein. You discuss that this indicates a relapse and that her child will need to restart systemic corticosteroids. The mother expresses concerns as her child finished a prolonged course of corticosteroids only 3 months ago and has heard that prolonged and/or repeated use of these comes with multiple potentially significant sideeffects including stunting of growth. She asks if there are ways to minimise or prevent these risks, and if anything will be done to monitor them. Supraphysiological doses of corticosteroids are used in the management of various medical conditions in children and young persons (CYP), but guidance on how to minimise and monitor adverse effects is limited in this population. There are also sideeffects that are specific to CYP, and as such require special monitoring. The aim of this article is to provide reasonable guidance that is extrapolated from the limited literature on this topic that is specific to CYP. It will not provide a comprehensive review of the properties and indications of corticosteroids. For the equivalent antiinflammatory doses to prednisolone 5 mg, refer to the British National Formulary for Children/National Institute for Health and Care Excellence 2020.