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There is no drug that worries parents more than corticosteroids. When I ask why parents are reluctant to give their child corticosteroids, fears of side effects often come up – thinning of the skin, poor growth, diabetes… Therefore, I want to tell you a little about corticosteroids, different types of corticosteroid treatments and its side effects.
What are corticosteroids?
Corticosteroids, or steroids, is the collective name for a group of different molecules that have the same effect as the vital hormone cortisol. Cortisol is formed by the adrenal gland and has a variety of effects on the body. To understand how important it is, I will tell you what problems arise for those who do not produce cortisol at all. A child who does not produce cortisol (a very unusual disease, but does occur) becomes tired, listless, nauseous, vomits, does not grow well, has low blood pressure and may have very low blood sugar without feeling it. Their salt level is, also, out of balance. Here’s an example. If a child who cannot produce cortisol gets a stomach bug, or a fever, the child can die within hours. This is because cortisol is absolutely necessary for the body’s defense against infection, and to trigger the body’s defense against fluid losses and excessively low blood pressure.
Cortisol is therefore both natural, or produced by our body, and vital!
Corticosteroids are a type of anti-inflammatory
Corticosteroids are a type of anti-inflammatory and treats diseases causing inflammation. Therefore, they are important in treating diseases.
Long term treatment of high dose corticosteroids causes severe side effects
Children with severe inflammations sometimes receive high doses of corticosteroids in tablet form, or in drips for a short or long period. These children get high doses of corticosteroids in the blood and consequently side effects. The three side effects that commonly occur on the first day of treatment are:
1. Wakefulness Children often have difficulty sleeping.
2. Mood swings. Children often become more rowdy, sometimes depressed, and sometimes upset. In my experiences, children commonly become more noisy.
3. Increase in appetite Children want to eat a lot of food, and often.
If the treatment is allowed to last for longer than a few weeks, the increase in appetite often results in weight gain. I always advise parents to give children the same portion size as before the treatment. And if they want extra snacks and evening meals, then give carrot sticks and cucumber sticks. Acid reflux is also common.
If the treatment lasts longer, the weight gain often settles on the abdomen and cheeks. At the same time, the muscles are broken down, which gives fat but rather sticky legs. Children can develop diabetes and stomach ulcers. Length or height growth is poor.
After a while, the body thinks that the adrenal glands no longer need to produce cortisol because so much comes from the medicine. Therefore, you must never stop a high-dose cortisone treatment, abruptly. Corticosteroids need to be tapered down slowly. Otherwise, life-threatening symptoms similar to those of other types of cortisol deficiency may occur. Follow the doctor’s prescription!
Lower doses of corticosteroid tablets have fewer side effects
Doctors who treat children with high-dose corticosteroids always try to reduce the dose as quickly as possible, taking into account the risks of the disease returning. Many children then stay on a low dose for a long time to prevent the disease from returning.
Single high doses of corticosteroids do not cause long-term side effects
Children with croup, intrinsic asthma or with severe allergic reactions, often receive a single high dose of corticosteroids in the pediatric emergency room. Children can have difficulty sleeping, and they can also have mood side effects for a few days. However, receiving single such doses does not cause long-term side effects. Height can probably be affected for a short time. However, if your child does not receive repeated doses often, then they grow accordingly to compensate.
Corticosteroid nasal spray is safe to give to children
Nasal sprays with corticosteroids (Nasonex, mometasone, Mommox, Orimox and more) are safe to give to children. Corticosteroid nasal spray is good for allergic nasal congestion. It is often given as a trial, even for chronic nasal congestion where as allergy is not confirmed.
Some children find the nasal spray stings, and some get nosebleeds as a side effect. However, Nasonex and similar nasal sprays are not absorbed into the bloodstream and do not cause systemic side effects.
Nasal sprays with corticosteroids are good for pollen allergy.
Corticosteroid inhalers to treat asthma has few side effects
Inhaled corticosteroids for asthma treatment (Pulmicort, Flutide, Giona Easyhaler, Symbicort in the several orange or brown spray cannisters) is absorbed into the blood to a very small extent. Treatment with asthma inhalers therefore never gives the side effects that high-dose cortisone treatment in tablets or drops gives.
Untreated asthma results in poor growth and poor quality of life in children. It also results in poorer muscle development as children with untreated asthma do not move as much as other children. In order for children with asthma to grow optimally, their asthma should be treated optimally. This often means inhaling corticosteroids every day.
If your child has asthma and you want to minimize possible side effects, you should give the inhalations via a spacer. Corticosteroid inhalations reduce the risk of admittance to the pediatric emergency room. If your child is admitted with an asthma attack, they will immediately receive a large dose of corticosteroid tablets with a greater risk of side effects.
Corticosteroid creams are an effective treatment against eczema
Corticosteroid creams, which are effective against eczema, are available in four different strengths: weak, medium, strong and extra strong. Their side effects differ between groups.
Weak corticosteroid creams are not absorbed into the bloodstream
All over-the-counter corticosteroid creams belong to the weak group. Hydrocortisone 1%, Mildison lipid are weak corticosteroid creams. They are not absorbed into the bloodstream at all and the only side effect we sometimes see is contact allergy to the drug itself. The side effect is rare, but worth considering if the child’s eczema gets worse and not better from the treatment.
I treat my own children with weak corticosteroid creams as soon as they get eczema. When the eczema is gone, they receive treatment every other day for a while and then stop. Then moisturiser is applied until it comes again. When the eczema reoccurs, I use hydrocortisone again, as much and for as long as needed.
Medium-strength cortisone creams can be absorbed into the bloodstream
Medium-strength cortisone creams, such as Locoid 0.1% or Emovat 0.05%, are prescription-only. They are used when weak corticosteroid creams fail to treat the eczema. Unlike weak corticosteroid creams, they can be absorbed into the bloodstream. The more you apply, the more it absorbs. However, you won’t see the side effects you see with high-dose tablet treatment. Not even for long treatment periods. When the eczema is clearly better, try switching to a weak corticosteroid cream. Follow the instructions given to you by your child’s doctor!
Strong corticosteroid creams often cause skin side effects
Strong corticosteroid creams, such as Elocon 0.1% and Betnovat 0.1%, I use less often for children. With long-term use (ie. months), they can cause skin thinning, stretch marks and they are definitely be absorbed into the bloodstream. However, strong corticosteroid creams also do not cause the side effects that high-dose corticosteroid tablets cause. When the eczema has clearly improved with strong corticosteroid creams, you switch to medium-strength ones. If the eczema is stubborn, however, you may need to continue applying the strong cream once a week to prevent relapse. Follow the instructions given to you by your child’s doctor!
Extra strong corticosteroid creams
Extra strong corticosteroid creams such as Dermovat 0.05% are not used on children.
The percentage says nothing about the strength of creams!
Notice in the examples above, that the strongest cream has a much lower percentage than the weakest! I included the percentages to demonstrate. Make sure that the tube is clearly labelled weak, medium or strong corticosteroid cream.