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Common prednisone side effects in kids

Although there are possible minor side effects of prednisone in kids, the medication’s benefits often outweigh any risk
Wendy Wisner
By | Dec. 10, 2024 Medically reviewed by Leslie Greenberg, MD
A prescription bottle with an exclamation mark on it: Common prednisone side effects in kids

Key takeaways

  • Prednisone is a steroid that’s typically given to children to treat cases involving inflammation, like asthma and allergies.

  • Some children experience side effects of mood swings, insomnia, appetite changes, and upset stomachs from prednisone.

  • Prednisone is typically prescribed for a week or less, and most of these side effects are temporary and go away when your child stops the medication.

  • Most pediatricians agree that when a healthcare provider prescribes prednisone, the benefits of prednisone outweigh the risk of possible side effects.

In this article:

Prednisone is a prescription corticosteroid that decreases inflammation in the body and suppresses the immune system. It is approved by the Food and Drug Administration (FDA) to treat many inflammatory conditions, including rheumatic, dermatologic, gastrointestinal, and respiratory issues. In children, prednisone is primarily prescribed to treat asthma and allergies, as well as a rare disease called nephrotic syndrome (NS) that affects the kidneys.

Prednisone is a generic medication that’s available under the brand names Deltasone, Rayos, Prednicot, Prednisone Intensol, and Sterapred. If your child has been prescribed prednisone or any of its brand-name versions, you might be concerned about possible side effects. Although prednisone side effects in kids may happen, and it’s understandable that you may have concerns, the Academy of American Pediatrics says the benefits of this medication usually outweigh any risks. Your child’s healthcare provider will help your child take prednisone safely. In the meantime, we’ll take a close look at prednisone side effects for kids, including how common they are, what they look like, and how to manage them.

What are common Prednisone side effects in children?

Prednisone side effects are relatively common. “They are similar in both kids and adults,” says Raj Dasgupta, MD, a quadruple board-certified physician specializing in internal medicine, pulmonology, critical care, and sleep medicine.

“Oral corticosteroids such as prednisone have side effects associated with both dose and duration of therapy, meaning that higher doses and longer use puts you at increased risk for side effects,” he explains. “Kids can sometimes be more sensitive to prednisone than adults, but it really depends on how much they’re taking and for how long.”

Claudia Cometa, Pharm.D., founder and CEO at Peace Advocacy Group, agrees that the side effects of prednisone experienced by kids are similar to those experienced by adults, with the main exceptions being delayed growth and bone thinning in kids. Side effects of delayed growth and bone thinning may be due to chronic use of prednisone, not short-term use. “In addition, the risk of infections due to suppression of the immune system can be more significant in kids,” Dr. Cometa says. Behavioral changes may also be more common in kids, she adds.

“Importantly, the severity of side effects depends on how long the child is taking prednisone,” says Shilpa Singh, MD, pediatrician and clinical department chair of pediatrics at Saint Anthony Hospital in Chicago. “Side effects are more common if used for more than two weeks,” she says. When used to treat asthma in kids, the medication is generally used on a short-term basis of about five to seven days. Short courses of medication reduce the likelihood of serious side effects.

Prednisone and mood changes

Prednisone may impact your child’s mood. For instance, you may notice your child seeming more moody, anxious, irritable—even angry. You may also notice that your child experiences more frequent mood swings.

Prednisone and appetite changes

Children taking prednisone may experience increased appetite, causing kids to eat more often and request larger quantities of food. When prednisone is taken long-term, this increased appetite may cause weight gain. Additionally, prednisone can lead to fluid retention, which can further increase weight gain.

Prednisone and delayed growth

When taken long-term, prednisone can impact your child’s growth, including potentially slowing their growth or decreasing their maximum height. It can also impact their bone mineral density and bone mineral content. These are issues your child’s healthcare provider will carefully monitor if your child is prescribed prednisone on a longer-term basis.

Prednisone and upset stomach

Prednisone can irritate your child’s stomach lining, leading to nausea and an upset stomach. You can avoid this by taking prednisone with food or using physician-approved antacids.

Prednisone and sleep

Difficulty sleeping is one of the most common side effects of prednisone in kids. Children may have trouble falling asleep or will sleep more restlessly. This is short-term and ends when your child stops taking prednisone.

Prednisone and behavior

Prednisone may cause children to act out and behave abnormally. Children may seem restless, anxious, and more argumentative. The medication can also decrease their ability to concentrate. These symptoms should be temporary and stop when your child is done taking the medication.

Prednisone and blood sugar

In some cases, prednisone can cause increased blood sugar (hyperglycemia). Your child should avoid or limit candy and high-sugar foods and drinks while they’re taking prednisone. Alert your child’s healthcare provider right away if you notice signs of high blood sugar, including excessive thirst, fatigue, and frequent urination, which may manifest as getting up in the night to eat or drink or urinate or having urinary incontinence.

Prednisone and swelling

Prednisone can cause your child to retain fluids. This can lead to swelling of the ankles as well as facial swelling (Cushing syndrome). Similarly, it can cause elevated blood pressure (hypertension). Sticking to a low-sodium diet can help decrease retention of fluids in the ankles. Still, you should connect with your pediatrician if you notice swelling in any part of your child’s body.

Prednisone and the immune system

Prednisone is an immunosuppressant, meaning that it lowers the immune system’s response. This can be helpful if your child’s immune system is overactivated, but taking prednisone comes with the side effect of making your child more vulnerable to infections, diseases, and injuries. It’s vital to discuss any concerns or necessary precautions with your child’s healthcare provider and let them know if your child shows signs of infection.

Prednisone alternatives for children

“Prednisone is a first-line treatment for asthma in kids,” Dr. Singh says. It’s used most frequently when children have asthma attacks, which can include serious trouble breathing and can be life-threatening if not treated promptly. Prednisone is usually given on a short-term basis to decrease inflammation in the lungs and reduce the chances of a subsequent asthma attack.

But prednisone isn’t right for everyone. Whether your child may be given an alternative to prednisone depends on the condition they have and how severe it is. “Alternatives to oral corticosteroids truly depend on what the kid is being treated for and the risks and benefits of switching to an alternative,” Dr. Dasgupta says. “This decision must be discussed in detail with the prescribing physician.”

In some cases of asthma, your child’s healthcare provider may prescribe an inhaled version of a corticosteroid. These tend to have fewer effects than oral steroids like prednisone. “In general, corticosteroids that you take by mouth can affect your entire body compared to topical or inhaled,” Dr. Dasgupta says.

Some parents may be curious about natural alternatives to prednisone. While there are natural prednisone alternatives that can decrease inflammation, there’s no evidence that they’re effective in treating serious pediatric conditions. “Natural alternatives for inflammation are not evidence-based therapies for medical conditions that need oral corticosteroids for treatment,” Dr. Dasgupta emphasizes.

Dr. Cometa says that there are sometimes natural remedies that can be helpful when used in conjunction with traditional medications. “For treatment of general inflammation, there may be options to use more natural anti-inflammatories, such as quercetin or curcumin,” she suggests. Although research has found that both quercetin and curcumin can be helpful with inflammation, there isn’t reliable or substantial research showing that it helps control conditions like asthma in children. Quercetin and curcumin aren’t remedies that pediatricians recommend.

Never stop prednisone or switch to a prednisone alternative without speaking to your healthcare provider. “You should always speak with your healthcare provider first if you are having side effects from oral corticosteroids and discuss possible alternatives,” Dr. Dagupta says. 

RELATED: Prednisone vs. prednisolone

How to manage prednisone side effects in children

The prednisone dose your child will be given will depend on their age, what condition is being treated, and their particular medical situation. “An average pediatric dose of prednisone would be 1–2 mg/kg/day divided once to twice daily,” according to Dr. Cometa, who notes that higher doses are typically associated with a higher incidence of side effects.

Dr. Dasgupta shared some strategies for minimizing side effects in children:

  • Administer prednisone with food to help decrease stomach upset.
  • Have your child take prednisone in the morning to minimize sleep disruption.
  • Keep an eye on your child’s diet, and make sure they are active to prevent weight gain.
  • If your child is taking prednisone long-term, make sure they are getting adequate calcium and vitamin D to protect their bones.
  • Have your child avoid salty foods since prednisone can cause water retention and raise blood pressure (hypertension), and salt worsens this symptom.
  • Avoid high-sugar foods, which can impact blood sugar and cause weight gain.

As Dr. Singh shares, there are certain medications it’s best to avoid if your child is taking prednisone, including:

  • Aspirin
  • Warfarin
  • Isoniazid
  • Furosemide
  • Antacids
  • Hydrochlorothiazide
  • Live vaccines, like the MMR vaccine

Again, it’s vitally important that you stay in touch with your healthcare provider before starting prednisone, taking other medications with it, or discontinuing it.

How long do prednisone side effects last?

The good news is that prednisone has a relatively short half-life, which is the amount of time it takes for its active substance to reduce by half in the body. Prednisone has a half-life of two to three hours. This means that the short-term possible side effects of prednisone resolve fairly quickly. “Some side effects, such as insomnia or stomach upset, typically resolve as soon as the medication is stopped,” Dr. Cometa says. On the other hand, the side effects that result from longer-term use take longer to resolve. “Other side effects, such as Cushingoid features, may take a few weeks to months to fully resolve,” Dr. Cometa says.

Talk to your child’s healthcare provider if you have any concerns about long-term side effects or about taking prednisone in general. They’ll be able to weigh the benefits and risks and discuss whether it’s worth exploring prednisone alternatives.  

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