Introduction

Steroids are a type of medication used to treat inflammation-related clinical conditions. Inflammation generally occurs due to the overactivity of the body’s immune system, which may affect individuals of all ages, including children.

Steroids among children are commonly used to treat medical conditions such as below:

1. Asthma
2. Juvenile arthritis
3. Kidney disease, e.g. Nephrotic syndrome
4. Skin disease, e.g. Eczema, dermatitis and psoriasis
5. Autoimmune disease, e.g. Multiple sclerosis and systemic lupus erythematous (SLE)
6. Hypersensitivity conditions, e.g. Allergic rhinitis, allergy reactions to food or medications

Steroids are also used on children who have undergone transplant surgery.

Examples of steroids approved for its use on children.

Steroids are available in the market in different dosage form e.g. tablet, syrup, cream, eye drops and inhalers. However, only products which are registered under the Ministry of Health are safe for use. All the registered products should have a valid MAL registration number, as well as the Meditag™ Hologram security sticker.

The main reason why steroids are prepared in different forms is to allow its effect to react at its maximum effect at the intended site. This will also reduce absorption of steroids into the systemic system and thus prevent incidence of adverse events, especially among the paediatrics group.

For example, steroid-containing inhaler should be inhaled deeply to allow drug delivery into the lungs in order to control asthma. However, some children who do not perform the proper technique may accidentally swallow the medicine which can cause fungal growth of the throat. Thus, parents should always assess their children’s inhalation technique.

Adverse effects of steroids in children

Signs and symptoms of adverse effects following steroids’ use can be different, depending on the duration of treatment.

Use of steroids for longer period (more than two weeks) may lead to adverse effects as below:

1. Bone thinning
2. Increase in blood sugar
3. Weakening of the body’s immune system
4. Disturbance in adrenal hormone secretion
5. Retardation of growth

On the other hand, short term use of steroids (less than two weeks) may cause adverse effects such as:

1. Weight gain
2. Limb and body swelling, due to water retention in the body
3. Emotional disturbance, e.g. Irritable and anxiety
4. Rise in blood pressure
5. Gastric disturbance, e.g. Gastric, vomiting and ulcer

Most of the diseases treated with steroids require longer duration, except in cases like allergic reactions. Parents should therefore monitor for adverse effects in their children. Seek for medical treatment and pharmacist advice if any of the adverse symptoms is detected.

Safe use of steroids

1. Steroids should be taken at the same time every day, preferably in the morning. If your child is taking steroids twice daily, the second dose is better taken late evening instead of bedtime in order to minimize sleeping disturbance.
2. Follow the dosage instructions given by your doctor. Do not double the dose even if you had missed a dose.
3. If your child shows symptoms of mouth ulcer, fever and flu, seek for medical treatment immediately. These might be signs of infections as a result of a weakened immune system possibly caused by prolonged use of steroids.
4. Use of steroids after a prolonged period (more than two weeks) should not be stopped abruptly. The dose has to be tapered down periodically before it can be stopped.
5. A steroid card will be given to your child if chronic use of steroids is required. Card ought to be kept available for the doctor’s reference upon clinic visits.

Misuse of steroids among children

Steroids are categorized as controlled medicine, which means they can only be obtained with a doctor’s prescription. Any use of steroids without the advice of a doctor or pharmacist is considered as a misuse.

It is a misuse of steroids when parents choose to treat their child independently with steroids without seeing the doctor. A common mistake parents make is when they use steroids on their child merely based on the symptoms, which is similar with children who were previously treated with steroids. In fact, not all medical conditions require steroids treatment. Self medicating your child without seeking advice from a doctor will put your child at risk of developing serious adverse effects.

Misuse of steroids may also occur when parents buy unregistered products, such as Chinese traditional medications, majun or jamu. These products are claimed to be “magical” and effective in treating various types of diseases. Due to the drug effect itself, these unregistered products are usually marketed as cure for sinus rhinitis, gout attack or joint pain.

The examples of unregistered products that were found to have adulteration of steroids are as below:

Extracted from: Pharmacy Services Division, Ministry of Health.
Senarai Produk Dikesan Mengandungi Bahan Terlarang (2015).

Use of products without knowing steroids adulteration in the content may cause harm to your children. Therefore, parents are urged to confirm that the products are registered under the Ministry of Health before purchasing. Avoid buying medications from the website or non-pharmacy outlets (such as grocery shop).

Conclusion

Steroids are safe for use among children, provided that its use is indicated by doctors and the method of administration is correct.

References

1. Aulakh, R. & Singh, S. (2008). Strategies for Minimizing Corticosteroid Toxicity: A Review. Indian Journal of Pediatrics, 75 (10), 1067 – 1073. Retrieved May 18, 2016, from http://medind.nic.in/icb/t08/i10/icbt08i10p1067.pdf
2. Liu, D., Ahmed, A., Ward, L., Krishnamoorthy, P., Leigh, R., Cohen, Albert., et al. (2013). A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Journal of Allergy, Asthma and Clinical Immunology, 9 (30). Retrieved May 18, 2016, from http://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-9-30