Corticosteroid Therapy in Children: Good or Bad?

Are you trying to understand the issue of Corticosteroid Therapy in Children and why your pediatrician recommends it so often? In this article, we look at what Bentelan or similar is used for, when it can be given to children, when it should actually be given, and when not to give it.

When to go for corticosteroid therapy in children?

After my remarks on the reckless use of antibiotics in Italy, to which I will certainly return in a dedicated article, remarks welcomed by patients and somewhat less so by some colleagues (which is saying something), I thought I would spend a few words on the (ab)use of cortisone in pediatric age.

Today the house proposes:

  • cortisone for COVID;
  • cortisone for fever;
  • cortisone for sore throat;
  • cortisone for cough;
  • cortisone for “bronchitis”;
  • cortisone for mild bronchospasm;
  • cortisone for bronchiolitis;
  • cortisone for otitis;
  • cortisone because “it has always been done that way.”

The most famous systemic cortisone drug (to be taken by mouth or by intramuscular or intravenous injection) is betamethasone, Bentelan for friends, available in tasty effervescent tablets

What is cortisone and what is it used for?

Cortisone constitutes a surprising class of anti-inflammatory drugs, more like a hormone than a drug and, as such, capable of altering metabolism and interfering with the immune response (it is in fact an immunosuppressant!).

Cortisone is very similar to our own cortisol, which we produce in the morning to better cope with the day, helping us to stay awake, and then declines in the evening by promoting rest at night.

As cortisol is higher in the morning, its anti-inflammatory action can be observed during febrile episodes: fever is always higher in the evening than in the morning.

Cortisone would be preferable to take it in the morning and not in the evening, especially in prolonged therapies (there are children who, after taking cortisone in the afternoon/evening, struggle to fall asleep).

And it would make sense to avoid it during infections, particularly viral infections unless its anti-inflammatory power is more important at that time than the inevitable negative effect on the immune response (i.e., when indicated).

Except for specific and necessary uses (e.g., oncology and rheumatology, major tonsillar hypertrophy with obstruction), corticosteroid therapy in children (to be taken, for example, by mouth) has limited indications in pediatrics (and thus limited prescribability under the National Health Service).

When should corticosteroid therapy in children be given?

Cortisone is very similar to our own cortisol, which we produce in the morning to cope better with the day, helping us to stay awake, and then drops in the evening favoring sleep at night.

Because cortisol is higher in the morning, its anti-inflammatory action can be observed during fever episodes: fever is always higher in the evening than in the morning.

It would make sense to avoid it during infections, particularly viral infections, unless its anti-inflammatory power is more important at that time than the inevitable negative effect on the immune response (i.e., when indicated).

When NOT to give cortisone?

Except for specific and necessary uses (e.g., oncology and rheumatology, major tonsillar hypertrophy with obstruction), systemic cortisone (to be taken, for example, by mouth) has limited indications (and thus limited prescribability under the National Health Service) in pediatrics.

Such as.

  • Acute laryngospasm and specifically dexamethasone at a dosage of 0.3-0.6 mg/kg, available for children in both oral drops (e.g., Decadron, Soldesam) and effervescent tablets (e.g., Varcodes). A single dose is usually sufficient for that single episode; it rarely needs to be repeated. Alternatively budesonide in aerosol, see Source 1.
  • Severe acute bronchospasm with desaturation and risk of, or has already occurred, hospitalization and need for ventilatory support (oxygen, high flows, etc.). See Source 2.
  • COVID? No. 97% of people healed without outcomes and without the need for ANY DRUG, with or without cortisone, with or without Tachipirin (paracetamol was, is and will be for a long time the safest painkiller and antipyretic at our disposal), with or without ibuprofen, and much less thanks to concoctions prescribed via WhatsApp by certain “distinguished” colleagues. The only sensible thing to do was vaccination, leaving alone cytokine storms, glutathione and Star Wars (just to say a third random thing).
  • Fever? No.
  • Pharyngitis (without tonsillar occlusion)? No.
  • Cough (barring laryngospasm)? No.
  • “Bronchitis?” No.
  • Mild bronchospasm? No.
  • Bronchiolitis? NO.
  • Otitis? NO.
  • Because “it has always been done this way and in fact every time I do this then after a few days I get better”? NO.

Which corticosteroid therapy in children is indicated?

A different matter is to be made for inhaled corticosteroids, in the form of nasal spray, aerosol or puff.

In this case the side effects are very limited as the drug acts only locally and is not absorbed more.

They may be indicated in adenoid hypertrophy (nasal spray, rhinowash), acute bronchospasm (as background therapy with fluticasone in puff – e.g., Fluspiral or in combination with bronchodilator in acute episodes), and acute laryngospasm (as an alternative to dexamethasone by mouth mentioned before: budesonide, e.g., Fluspiral. Bodix, Pulmaxan, Aircort at a dose of 2 mg as an “attack dose,” followed by 1 mg every 12 hours for 2-3 days, until the dry barking cough, WITH FALLING VOICE, becomes “fat”).

“But my son is always prescribed aerosol with 1 vial of budesonide 0.25 mg/mL (total 0.5 mg) when he has a cough.”

“I don’t know what to tell you.”

They can also be used in the form of creams/ointments in SEVERE forms of atopic dermatitis that worsen despite daily application of emollient creams, and for FEW days anyway.

The therapeutic dosage of betamethasone, as moreover stated in the package insert, is in pediatric age 0.1-0.2 mg/kg (Source 3).

A 10 kg child with severe bronchospasm will therefore need to take 1-2 mg daily.

“But my 10 kg son is always prescribed one 0.5 mg tablet a day when he has a lot of cough.”

“I don’t know what to tell you.”

To elaborate, you will find several sources at the bottom of the article.

We are with you.

We at Parentalife are always very focused on quality dissemination and thank Dr. Cuffaro for these very specific contributions. We also support you in the daily routine of life with your child with our classes and consultations.

You will never be alone in this journey; we are with you.

SOURCES

1. https://www.medicoebambino.com/index.php?id=CM0805_10.html
2. https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://ginasma.it/wp-content/uploads/materiali/2019/GINA_pocket_ita_2019.pdf&ved=2ahUKEwik-crCvNGEAxUDR_EDHSsHArIQFnoECCMQAQ&usg=AOvVaw3SgZ6kLOtwSeUM9EJQpry_
3. https://www.codifa.it/…/betametasone-doc-generici…

About the Author

Giorgio Cuffaro - Paediatrician