Corticosteroid medicine

  • Corticosteroid medicines are synthetic (created in a laboratory). They are similar to the steroid hormones produced naturally in the body by the adrenal glands. Corticosteroids are commonly used to treat problems caused by inflammation (e.g. asthma, croup, inflammatory bowel disease), tumours or muscular degeneration (e.g. Duchenne muscular dystrophy).

    There are several different types of corticosteroid. The form most commonly used in Australia is prednisolone, which comes as a syrup or tablet.

    The information in this fact sheet relates to long-term use of corticosteroids (e.g. for several months to treat Crohn disease), and most of the information is not applicable to children taking the medicine for a short time only (e.g. for a week to treat croup).  

    Why does my child need corticosteroids?

    Doctors prescribe corticosteroids for a number of different conditions, including:

    • Asthma, croup: Many conditions that involve inflammation and swelling of the airways will respond to corticosteroids. When used for these conditions, treatment is usually limited to two to three days at a time.
    • Inflammatory bowel disease (IBD): IBD includes Crohn disease and ulcerative colitis. Corticosteroids may be helpful in controlling the inflammation that causes IBD flare-ups.
    • Duchenne muscular dystrophy (DMD): Corticosteroids have been proven to slow the progression of muscle weakness in children with DMD. Corticosteroids can help preserve muscle strength and function in children with DMD, and may also help preserve the heart and breathing muscles. 
    • Autoimmune disease: In these conditions, the body's immune system mistakenly attacks parts of the body. Corticosteroids help to dampen the immune response, reducing the symptoms in severity and duration.

    Before giving your child corticosteroids

    If your child has previously had a bad reaction to any steroids or other medications, tell your doctor. Corticosteroids weaken the body's natural immune system, so it is important to notify your doctor of any current or recent illnesses or exposure to infection (e.g. chickenpox).

    Before prescribing corticosteroids, the doctor will also find out whether your child has any of the following problems:

    • diabetes or blood sugar problems
    • stomach or intestine problems
    • eye problems (e.g. glaucoma)
    • heart, kidney or liver problems
    • bone problems (e.g. weak bones)
    • high blood pressure
    • behavioural problems.

    It is still safe for your child to have corticosteroids if they have these conditions, but they may need extra monitoring or closer management by their doctor.

    Are there any side effects of corticosteroids?

    Long-term use of corticosteroids can result in many possible side effects. The chances of these occurring depend on the individual child and the dose of corticosteroid they are taking. The most common steroid side effects are:

    • weight gain
    • roundness of the face
    • mood changes (irritability, hyperactivity)
    • slower growth rate
    • loss of calcium from the bones (osteoporosis)
    • development of cataracts (clouding in the eyes)
    • a slight increase in body hair, especially on the arms, legs and back.

    Other possible side effects include difficulty sleeping, headaches, mild stomach aches, mild acne and dry skin.

    There are also some rare side effects including high blood pressure, diabetes, increased chances of infections, thinner skin, increased sweating, dizziness, depression and/or hallucinations.

    It is important that you talk about any possible side effects with your doctor. The doctor will prescribe the lowest dose of corticosteroid possible, while still ensuring the medicine will help your child's condition. If your doctor is recommending corticosteroids, the benefits of treatment outweigh the risks of side effects.

    Regular health checks

    Your child should have regular general health checks so doctors can watch out for possible corticosteroid side effects. These health checks should include:

    • measurement of height and weight
    • blood pressure
    • urine screening 
    • lung-function test
    • muscle-strength test
    • calcium in bones (by a bone density, or DEXA, scan)
    • eye check-up.

    Reducing osteoporosis

    It is very important for children on long-term corticosteroid treatment to have plenty of calcium and vitamin D to avoid developing osteoporosis. Dietary supplements of vitamin D and calcium are generally recommended for children on regular steroid therapy.

    Minimising weight gain

    Your child should have a low-fat, low-salt diet to assist in controlling weight gain. Limit red meats and saturated fats, and encourage fresh fruit, vegetables, water and fat-free milk. Plenty of exercise is also very helpful in a variety of ways.

    Giving corticosteroids

    Always follow the doctor's or pharmacist's instructions when giving corticosteroids. It is best to take the corticosteroids in the morning, as this will help to reduce weight gain. A single daily dose with breakfast is usually best.

    • If a dose is missed it can be taken at lunch time on the same day but not later. Do not take a double dose if one is missed. Contact your doctor if your child misses more than one day of medicine.
    • Corticosteroids do not usually interact with other medicines. However, it is important to check with your pharmacist or doctor before starting any other medications, including non-prescription, complementary or natural medicines.

    It is very important that your child does not suddenly stop taking corticosteroids. This is because the body becomes used to their effect and needs time to adjust. Talk to your doctor about reducing the dose slowly. Never change your child's corticosteroid dose without your doctor's advice. 

    • Your child's steroid dose may need to change depending on their weight and any side effects they may experience. Talk to your child's doctor about this.
    • If your child becomes very unwell, they may need to take higher doses of the corticosteroid medicine (called stress doses) or be given intravenous (IV) corticosteroids (directly into a vein through a drip). This is because the body uses the natural steroid cortisol to help react to sudden stressful events such as infections, accidents or surgery. Your doctor will advise you of any dose changes.

    Immunisations and corticosteroids

    Most children will have had all their immunisations by the time they take long-term corticosteroid medicine. If your child is due for immunisations, discuss them with your child's doctor, because children who are taking corticosteroids should not have live vaccines such as the MMR (measles, mumps, rubella) vaccine while they are on the medication. Short-term use (e.g. for croup) does not affect immunisations. 

    If your child has not had chicken pox, it is important that they have the varicella (chicken pox) vaccination before starting corticosteroids. Chicken pox infection can be very severe in children on corticosteroids. 

    Key points to remember

    • Corticosteroid medicines are similar to the steroid hormone cortisol, which is produced naturally in the body.
    • Corticosteroids have many possible side effects, depending on the individual child and the dose they are taking. Discuss potential side effects with your child's doctor.
    • The steroid dose may need to change if your child is very unwell or has problems with side effects.
    • Corticosteroids must never be stopped suddenly.
    • Always check with your child's doctor before giving any other medications, including those that don't need a prescription.

    For more information

    Common questions our doctors are asked

    Will the side effects go away once my child has stopped taking corticosteroids?

    The side effects from corticosteroids usually disappear once the treatment ends. However, it can take many weeks to return to normal.  

    Can corticosteroids cause any behavioural problems?

    One of the potential side effects of corticosteroid medicine is mood change, such as irritability, and this can lead to difficult behaviour in some children. When used short-term, it can increase blood pressure and blood sugar levels, causing some children to become hyperactive. For this reason, it is always recommended to be given in the morning, so there is less impact on sleep.

    Are corticosteroids the same as the steroids that are banned for use by sportspeople?

    No. Corticosteroids are not the same as the (anabolic) steroids that some athletes use to make them stronger or faster, and which are banned in many sports.

    My child has been prescribed a steroid cream. Are the side effects the same?

    Topical steroids (steroid creams and ointments applied directly to the skin) have fewer side effects than steroids given orally or through an IV drip (directly into a vein). Thinning of the skin is a common concern but rarely occurs. With long-term use (weeks to months of daily use), the skin may develop stretch marks or bruising and hair growth may increase in the treated area.

    Developed by The Royal Children's Hospital Neurology and Pharmacy departments. We acknowledge the input of RCH consumers and carers.

    Reviewed August 2018.

    This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

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