9 Prednisone Side Effects to Watch for in Kids

If your child has ever had an asthma attack, they may have been prescribed prednisone for a few days. But what exactly is this medication, and is prednisone for kids safe?

Prednisone is a corticosteroid. Corticosteroids are manufactured versions of the natural hormones made by your adrenal glands — the small organs that sit on top of your kidneys. Corticosteroids help reduce inflammation and downregulate (turn off) the immune system. Corticosteroids are different from anabolic steroids, which are the steroids athletes sometimes use to build muscle.

Corticosteroids like prednisone can help treat inflammation or an overactive immune system. Prednisone can be a lifesaving treatment for sick kids. But like all medications, prednisone can cause side effects. Let’s look at the side effects of prednisone in kids and what to look out for if your child needs this medicine.

Is prednisone safe for kids?

Prednisone is generally safe for kids — especially when taken at low doses and for short periods of time. Researchers have noted that prednisone side effects are less likely when kids take it for less than 2 weeks. But if your child needs to take high doses of prednisone, or they need to stay on prednisone for a long time, then they’re at greater risk for developing side effects.

How long a child needs to take prednisone depends on their medical condition. There are some common reasons prednisone is prescribed to kids. 

Prednisone may be prescribed for short-term use to treat:

• Asthma attacks

• Bad poison ivy rashes

• Allergic reactions

Prednisone may be used long term for things like:

• Asthma control 

• Adrenal insufficiency 

• Cancer treatment, especially leukemia

• Autoimmune conditions like juvenile idiopathic arthritis

• Kidney diseases like nephrotic syndrome

The risk of side effects also depends on how prednisone is taken. Steroids can be taken: 

• By mouth

• Through an inhaler

• As a nasal spray

• As a topical cream

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Steroids taken by mouth are much stronger than other forms of prednisone. Prednisone pills may have as much as 100 times the dose of steroids that are in inhaled or topical steroids. Children using an inhaled corticosteroid or a topical steroid cream are less likely to have serious side effects compared to kids taking high doses of prednisone by mouth. 

What side effects can prednisone cause in children?

Prednisone is a powerful medication, with a lot of different actions on the body. For those reasons, taking prednisone can cause significant side effects. The good news is that many side effects are short-lived — especially if kids only need to take prednisone for a short time. 

Most kids only need a few days of oral prednisone at one time. And side effects typically go away quickly once they’re finished taking their medication.

But there are nine common side effects to be aware of when your child is taking prednisone. 

1. Weight changes

Children may gain weight when taking prednisone. This side effect happens more often with long-term use — when they’re taking it for longer than 1 month. Prednisone leads to weight gain by causing:

• Increased appetite

• Changes in how the body processes sugars and fats

• Production of more fat deposits — especially in the face, neck, and stomach

• Fluid retention 

Children can counter these effects by eating a diet low in processed and high-sugar foods. It’s also helpful for them to get regular exercise. Children shed this extra weight when they stop taking prednisone. One small study found that children who took steroids for up to 3 years went back to their pre-treatment weight within 6 months of finishing steroid treatment. 

2. Mood and behavior changes

Some children experience mood and behavior changes when they take prednisone. Experts don’t know exactly why this happens. Research shows prednisone can affect different brain chemicals called neurotransmitters. Prednisone may also bind with steroid receptors in the hippocampus. This part of the brain controls emotions and memory.

Prednisone use can cause behavior changes, such as:

• Irritability or angry outbursts

• Depressed mood

• Anxiety

• Restlessness or feeling jittery

• Confusion

• Hearing voices or seeing things that aren’t there 

These side effects can seem frightening to both you and your child, but they’re temporary. They can happen at any time during steroid treatment and even when coming off this medication. 

If your child has behavior changes when taking steroids, try these tips:

• Keep a regular routine. 

• Provide a quiet place for your child (or for you) to calm down when needed.

• Explain to your child that these feelings are temporary and will get better.

• Try deep breathing exercises or other relaxation techniques.

3. Trouble sleeping

Many kids have trouble getting to sleep. Oral steroid medications can make getting a good night’s rest even more difficult. This can be a problem even with short-term use of prednisone. One review of kids who took short-term steroids found that 4% of children experienced this side effect. But this is most often seen with oral steroids. Inhaled corticosteroids to control asthma can actually improve sleep in kids with asthma. 

How can you help a child struggling with sleep while taking prednisone? The solutions are the same as they are for other sleep issues:

• Keep a regular sleep routine each night.

• Try to include calming activities before bed, like reading a book.

• Avoid electronics for about an hour before bedtime. 

4. High blood pressure

Steroids can cause the body to hold onto salt and water. That can lead to fluid retention (weight gain) and raise blood pressure. 

High blood pressure can happen with long-term use of oral corticosteroids. Your child’s healthcare professional will keep a close eye on your child’s blood pressure. They may recommend diet changes and medication treatment if your child’s blood pressure remains high.

5. Stomach irritation

Oral prednisone can irritate the stomach. This can happen even with short-term use. It’s more likely when kids are taking nonsteroidal anti-inflammatory (NSAID) medications like ibuprofen at the same time. 

To help avoid this side effect of prednisone, try giving prednisone with food or immediately after eating. If your child needs steroids long term, your child’s healthcare professional may add an antacid medicine like famotidine or omeprazole to help protect their stomach.

6. Acne

Some kids on prednisone will develop skin changes called steroid-induced acne. Steroid-induced acne can appear on the chest, back, neck, and face. Most often this side effect happens with long-term use of steroids. But some people may get acne with shorter periods of treatment with high doses of prednisone. 

It’s not clear exactly how steroids like prednisone can lead to acne. But research has shown that glucocorticoids (the natural steroid produced by your adrenal glands) can affect sebum production. Sebum is the natural oil produced by sebaceous glands in your skin. Increased oil can lead to blocked pores and pimples.

Fortunately, steroid acne clears up when children stop using prednisone.

7. Bone-thinning

Kids build over 90% of their bone mass during childhood and adolescence. Steroids like prednisone can interfere with this bone formation. This can cause bones to become weak and break more easily. Studies in adults show that these changes can start after just 2 weeks of steroid treatment. 

Children who need steroids long term should be assessed to make sure they’re getting enough calcium and vitamin D — two nutrients needed for bone growth. They may also need bone density testing to look for signs of bone weakening. If your child’s pediatrician identifies too much bone thinning or osteoporosis, treatment options include: 

• Vitamin D and calcium supplements

• Weight-bearing exercise

• Medications called bisphosphonates

8. Trouble growing

Bone changes caused by prednisone can interfere with your child’s overall growth. Kids taking prednisone can have trouble growing due to:

• Less new bone being formed

• Bone reabsorption (the process of bone loss in the bone that your child has already formed)

• Changes in growth hormone production

Again, these side effects of prednisone depend on the form of steroid that your child is taking and how long or how often they’re taking it. It’s hard to know for sure whether long-term steroid use affects how tall a child would have been — this is also called their final adult height. Studies have been conflicting. There’s evidence that some kids with reduced growth due to steroids may “catch up” after the medication is stopped.

9. Higher risk for infections

Prednisone can help treat an overactive immune system. This is helpful when dealing with autoimmune conditions, which develop when the body’s immune system attacks normal, healthy cells. But this effect of prednisone also weakens a child’s immune system. That means your children may have trouble fighting off certain infections. These include chicken pox and measles.

It’s important to make sure your child is up to date on their vaccines so that they don’t get sick with these viruses while taking prednisone. Keep in mind, kids who are taking high doses of oral prednisone for more than 2 weeks may need to delay getting live vaccines. That’s because the vaccines might not work as well while they’re taking prednisone. Talk with your child’s pediatrician to come up with a vaccination plan for your child.

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Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

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