Principles of the use of glucocorticosteroids in the growing child.
The use of glucocorticosteroids in children presents special problems because of the suppressive effects on growth and on the hypothalamic-pituitary-adrenal axis. This review summarizes the pathophysiology of glucocorticoid action and outlines suggested guidelines for monitoring children treated with these drugs. There is no "magic formula" for corticosteroid use in children, except to say that it is safest to use the smallest possible dose for the shortest period of time. Growth and hypothalamic-pituitary-adrenal suppression may be minimized by giving alternate-day or single morning doses and avoiding long-acting preparations. Therapy during puberty and infancy has the greatest chance to produce permanent loss of ultimate height. Growth should be documented by accurate measurement, plotting the data on growth charts. During therapy and while the hypothalamic-pituitary-adrenal axis remains suppressed, written emergency instructions for glucocorticoid therapy should be provided to patients, and they should wear identification indicating that they are taking these agents. Above all, therapy must be individualized.
D000287:Administration, Topical; D000293:Adolescent; D002648:Child; D002657:Child Development / Q000187:drug effects; D002675:Child, Preschool; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006128:Growth / Q000187:drug effects*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D007223:Infant; D010913:Pituitary-Adrenal System / Q000187:drug effects
D005938:Glucocorticoids