What Are the Dangers of Steroids in Toddlers?
Corticosteroids hold great promise in the treatment of an array of conditions, from asthma to rashes. The use of medications such as cortisone, hydrocortisone, and prednisnone carries potential side effects, especially in children. Parents and doctors must evaluate the benefits and risks of treating a young child with these medications and work together to craft a solution that benefits the whole child.
Significance
A couple of new studies published in 2009 in the New England Journal of Medicine called into question the regular use of oral or inhaled steroids to treat wheezing and asthmatic symptoms in young children. While doctors want to comfort children and reassure their parents by helping them overcome wheezing due to allergies or viruses, the studies show that the steroid treatments have little benefit and might stunt growth or impact bone density. Occasional use of topical corticosteroids such as hydrocortisone doesn't appear to pose serious risks, even for young children, but the lowest dose possible should be used for the shortest time possible to minimize exposure and lessen the possibility of side effects.
Considerations
While steroid use to treat occasional wheezing has been proven ineffective, the benefits of using steroids to treat children under the age of 5 with moderate to severe asthma often outweigh the risk of side effects. The side effects of steroid use, including bone mineral density and a slower rate of growth, are often reversible and rare, according to Dr. Alan Greene of DrGreene.com.
Warning
Inhaled steroids are one of the most effective treatments for asthma in adults and children over the age of 5, but there is little research into their safety or effectiveness among very young children. Since 80 percent of children experience their first asthma attack prior to the age of 5, it is critical that these children are diagnosed and treated early so that serious attacks can be managed or prevented. If a child's growth rate seems to be impacted by the steroids, parents and doctors must determine whether the steroids continue to be the most beneficial treatment for the child.
Potential
The Food and Drug Administration evaluated and approved a steroid medication called Pulmicort Respules to be used in treatment of children as young as 1 year. This medication is administered via a nebulizer, which can be a difficult way to administer medications to an active toddler since they must remain still for a period of time with a mask on their face. Another medication called Cromolyn is also available for the nebulizer. Singulair, a leukotriene modifier administered in tablet form, is another alternative to steroid therapy and carries the FDA approval for ages 2 and older.
Expert Insight
Dr. Stan Szefler, head of pediatric clinical pharmacology at Denver's National Jewish Health, a top-rated hospital for respiratory conditions in the U.S., offered this advice for parents trying to make a decision on steroid usage: "Have your doctor evaluate whether your child has features of asthma. Look at the family history, particularly the parents' history of asthma. Take into consideration whether the child has eczema or other signs of allergy. If there's wheezing between colds, such as with exercise, that's an indication that some form of asthma might be involved. Then, you would start to think of preventative therapy to reduce the impact of the disease. That would be inhaled steroids or Singulair."
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