Risks of Short Term Oral Steroids in Children: How Big Are they?

Overall Magnitude of Risk is Low But Proper Assessment of Risk and Benefit is Always Needed

Oral steroids like prednisone are sometimes given short term is cases of rapidly progressing alopecia areata in children. Duration can vary but prednisone for 3 weeks to 10 weeks is not uncommon. The most common side effects of prednisone include weight gain, poor sleep, and irritability. A new study reminds us that short term treatments are still associated with other potential side effects including an elevated risk of GI bleeding, sepsis and pneumonia. Fortunately, the risk of these more serious side effects were found to be very low.

A study from Taiwan examined whether very short term oral corticosteroid use (less than 14 days) was associated with potential harm. The authors studied over 1 million children who received oral steroids and compared data to over 3 million children who did not. The researchers examined whether children using oral steroids had an increased risk of GI bleeding, sepsis and pneumonia.

The study showed that children receiving oral steroids for under 14 days had a very slight 1.4 fold increased risk of gastrointestinal bleeding, 2.02 fold increased risk of sepsis and 2.19 fold increased risk for pneumonia.

The absolute risk overall was low and that is a key point not to be missed in this large study. Children rarely develop gastrointestinal bleeding, sepsis and pneumonia. The use of short term oral steroids increases the risk of developing these issues but only very slightly. The vast vast majority of children using short term steroids would not have develop of these issues. This study is important for physicians to know about and understand. Those who don’t understand the proper interpretation can skew the interpretation of data to cause unnecessary panic to parents whose children can benefit from these medications. For many children who might need these medications for various medical indications, the benefits may still far outweigh the low risk for these types of side effects. Together, parents and physicians need to carefully evaluate the risks and benefits of all treatments and take into account the magnitude of risk when making decisions.

Reference

Yoo et al. JAMA Pediatr. Published online April 19, 2021.