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Are Steroids Bursts Safe for Children?

May 27, 2021

Written by Clay Smith

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Short steroid bursts were associated with an increased risk of several serious complications in children.

Why does this matter?
We know short bursts of steroids are associated with harm in adults. What about children?

Steroids may not be benign even in children
This was a large population database study with over 4.5 million children total followed over 4 years, and just over 1 million who were prescribed < 14 days of steroids. Among exposed patients, the incidence rate ratios, “within 5 to 30 days after initiating corticosteroid bursts were 1.41 (95% CI, 1.27-1.57) for GI bleeding, 2.02 (95% CI, 1.55-2.64) for sepsis, 2.19 (95% CI, 2.13-2.25) for pneumonia, and 0.98 (95% CI, 0.85-1.13) for glaucoma.” In other words, children who received short bursts of steroids had a twofold or greater risk for some serious complications (glaucoma excepted). Steroids have a role in severe asthma, severe pharyngitis, croup, and other acute illnesses in children. For these indications, the benefit almost certainly outweighs the risk. However, steroids are often prescribed for very weak indications, even for simple colds. This is not only ineffective, it’s likely harmful.

Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children. JAMA Pediatr. 2021 Apr 19. doi: 10.1001/jamapediatrics.2021.0433. Online ahead of print.

What are your thoughts?