LS is an 8-year-old girl who has been having a tough time with her asthma. After a recent flare-up that sent her to the emergency room, her doctor prescribed a short course of oral corticosteroids to help reduce the inflammation in her lungs. Her parents were nervous as they had heard about corticosteroids side effects and were not sure what to expect.

If you are a parent or caregiver facing similar questions, this article is the second of a three-part series that will cover some of the considerations for safe pediatric medication use. Corticosteroids are available in different dosage forms. We would like to invite you to read our July 2025 article on “Pediatric Dosage Forms: Safe Medication Use Considerations”. Here we highlight how corticosteroids work, how to use them safely, and what steps you can take to protect your child’s health.

How Corticosteroids work

Corticosteroids are medications similar to hormones made naturally by the adrenal glands in our body. There are two main types – glucocorticoids, which help reduce inflammation, control the immune system, and narrow blood vessels; and mineralocorticoids, which help mqanage electrolyte and water balance in the body.

Corticosteroids are used to treat many different health conditions in children, including, but not limited to:

•  Breathing conditions, like asthma, croup

•  Skin conditions, such as eczema, alopecia, vitiligo

•  Digestive issues caused by inflammation, like ulcerative colitis, Crohn’s disease

•  Other autoimmune and inflammatory conditions, including those that affect joints, blood, hormones, nerves, or kidneys

Common side effects of corticosteroids

Corticosteroids can be prescribed for either short-term use (less than 14 days) or long-term use (more than 15 days). Depending on the duration of use, different side effects (https://www.ncbi.nlm.nih.gov/books/NBK531462/) may occur.

For short-term courses of corticosteroids (e.g., for allergic reactions, asthma flare-ups, or sudden worsening of autoimmune conditions), some children may experience side effects like nausea, vomiting, behavioural changes (e.g., anxious, restless, or hyperactive), sleep disturbances, etc. For long-term courses of corticosteroids (e.g., for chronic conditions like asthma, chronic obstructive pulmonary disease (COPD), inflammatory bowel disease (IBD)), side effects may include weight gain, slower growth, fatigue, slower wound healing, bone pain, etc.

Safe medication use considerations

Prescribers generally aim to use corticosteroids in the safest way possible for your child. This means giving the lowest possible dose for the shortest duration needed. If long-term corticosteroid therapy is necessary, prescribers would monitor certain aspects of your child’s health conditions (e.g., weight, height, bone health, nutrition, blood sugar level, stage of puberty, mood, behaviour, sleep, etc.). 

It is important to note that certain side effects may occur as early as one week after starting corticosteroids therapy, and some are more likely to occur with higher doses. If corticosteroids need to be discontinued, it should always be done slowly and under a health care professional’s guidance and monitoring.

Resources for safe pediatric medication use

Helping your child use corticosteroids safely starts with good communication and staying organized. One helpful tool that can be recommended to LS and her parents is the Institute for Safe Medication Practices Canada (ISMP Canada) “5 Questions to Ask About My Medicine – For Kids” – a pediatric focused medication safety resource that was co-designed by children, caregivers, and health care providers to facilitate conversations with prescribers or pharmacists during a medical appointment or patient consultation, respectively. An implementation guide is also available to accompany this resource.

In addition, it is also helpful to keep a list of all medications that your child is taking, including any over-the-counter drugs or supplements, as some of them may interact with corticosteroids. Using a calendar or a reminder system can keep doses on track, especially if corticosteroids need to be taken at certain times or if they need to be slowly tapered or reduced in doses. Be sure to store medications safely. If a dose is missed or if you are unsure what to do after a missed dose, reach out to your healthcare provider for guidance. With communication and support, you can help ensure your child’s corticosteroids use is safe and effective.

Samir Kanji and Laura Brady are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor, Teaching Stream, at the Leslie Dan Faculty of Pharmacy and Department of Psychiatry, University of Toronto.

By Samir Kanji, Laura Brady, and Certina Ho