Can Steroids Stunt a Child’s Growth?
Key takeaways:
Corticosteroids are generally safe medications, but they can cause side effects, like growth suppression (stunted growth) in children.
Children are more likely to experience growth suppression if they take high doses of steroids daily for long periods of time.
To help lower the risk of stunted growth, children should take the lowest possible dose of steroids on an alternating-day schedule or with breaks.
Corticosteroids, like prednisone, are medications that decrease swelling and inflammation in the body. They can treat many medical conditions, like asthma, allergic rhinitis, rheumatoid arthritis, and psoriasis.
While steroids can be life-saving medications, many parents and caregivers worry about the potential health impacts that steroids can have on kids. One common worry is whether steroids can stunt a child’s growth. While it’s true that steroids can impact growth, not all steroids have the same effects.
Do steroids affect a child’s growth?
Sometimes.
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Steroids can affect a child’s growth through several different mechanisms. For example:
Steroid medications decrease the body’s natural release of growth hormone. This hormone promotes linear growth and lets children achieve adult height.
Steroid medications also decrease bone formation. This is why people who take steroids are more prone to osteoporosis (bone thinning). In kids, reduced bone formation can also impact their final adult height.
But it’s important to note that effects on a child’s growth aren’t always noticeable. For example, a child taking a 5-day course of low-dose prednisone to treat an asthma flare may experience a temporary decrease in growth hormone levels or bone formation. But once the steroid treatment ends, their body’s functions go back to normal. And these brief changes don’t make a difference in the child’s eventual adult height.
On the other hand, a child who has to take high doses of steroids every day for months will experience these changes for longer periods of time. And this can impact their final adult height.
Your child’s risk of stunted growth depends on:
The steroid dose: Higher doses are more likely to impact your child’s growth than lower doses.
The duration of treatment: In general, children who need to take steroids daily for more than 3 months are at an increased risk of side effects like growth suppression.
How steroids are taken: Oral steroids and intravenous (IV) steroids are more likely to significantly impact your child’s final adult height. Inhaled corticosteroids go directly into the lungs. But they may still impact your child’s growth to a lesser extent. One study showed that inhaled steroids decreased final adult height by about 1 cm. Newer studies show that intranasal steroids may also cause small changes in your child’s adult height. Like inhaled steroids, the effects may be mild. Steroid creams are the least likely to impact your child’s height unless they’re used at high doses for an extended period, over a large area of the body.
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What steroid doses are considered high for children?
It depends on the type of steroid a child is taking and how long the steroid stays in their body.
Each type of steroid has its own strength or potency. And that potency is affected by the type of steroid that is being taken. Steroids taken by mouth or through an IV are generally more potent than those taken through an inhaler, nasal spray, or cream.
Also, each type of steroid behaves differently. Some stay in the body longer than others. For example, oral hydrocortisone can last up to 12 hours in your body, while prednisone can last up to 36 hours.
Stronger steroids, and those that linger in the body longer, will have a much more significant effect on your child’s height. There are dozens of different steroids available in various doses, concentrations, and forms. And what’s considered a “high dose” depends on your child’s weight. These factors make it impossible to give a full list of what’s a high dose for your child. Talk with your child’s care team about the dose and strength of the steroid your child is receiving. This can help you figure out if your child is at risk for growth suppression.
How can you prevent growth suppression in children if they take steroids?
Growth suppression is a well-studied side effect of steroids. Healthcare professionals use several strategies to lower your child’s risk of growth suppression if they need to take steroids for a long time.
Some things that can help prevent growth suppression during steroid treatment include:
Alternating day regimens: Taking corticosteroids every day can significantly impact your child’s growth. Alternating day regimens help lower the risk for growth suppression. Your child’s pediatrician or other healthcare professional may suggest taking steroids every other day or only 3 to 4 times a week.
Prescribing the lowest possible dose: Healthcare professionals will prescribe the lowest possible dose to treat your child’s condition. If your child doesn’t improve, their healthcare professional may wait before trying a higher dose. This allows your child to adjust to the medication before being exposed to side effects.
Calcium and vitamin D supplements: Your child may be prescribed calcium and vitamin D supplements, if they need to take steroids for a long period of time. These supplements support bone health and growth.
Frequent height checks: Your child should have their height checked every 6 months if they’re taking long-term steroids. Children tend to grow about 1.5 inches per year prior to puberty. If your child’s growth is slower, their healthcare professional may recommend growth hormone. In children who are having significant growth suppression, prescribed growth hormone has been shown to help decrease the height-stunting effects of the corticosteroids.
The bottom line
Corticosteroids can help treat many medical conditions. But long-term daily use of corticosteroids — especially oral or IV steroids — may impact your child’s growth. Intranasal and inhaled corticosteroids can also decrease growth, but to a much lesser extent. If your child is needing to take a prolonged course of steroid treatment, it’s important to monitor their height and work with their healthcare professional to lower the risks of growth suppression.
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References
Bensch GW. (2016). Safety of intranasal corticosteroids. Annals of Allergy Asthma and Immunology.
Briot, K., et al. (2015). Glucocorticoid-induced osteoporosis. RMD Open.
Hochberg, Z. (2002). Mechanisms of steroid impairment of growth. Hormonal Research
Hodgens, A., et al. (2023). Corticosteroids. StatPearls.
Liu, D., et al. (2013). A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma and Clinical Immunology.
McKay, L. I., et al. (2003). Physiologic and pharmacologic effects of corticosteroids. Holland-Frei Cancer Medicine.
National Eczema Association. (n.d.). Risks of topical corticosteroids.
Wolfgram, P. M., et al. (2015). Factors influencing growth effects of inhaled corticosteroids in children. Journal of Allergy and Clinical Immunology.
