Corticosteroids or steroids are medications similar to the steroid hormones produced naturally in our body by the adrenal glands, which are the two small glands placed on top of the kidneys.
They should not be confused with anabolic steroids, which mimic the effects of the hormone testosterone and will not be covered in this article.
Steroids are available in different forms: oral, injection, topical (cream), inhaled and nasal.
They are generally safe if the dose is low and they are used short term, e.g less than two weeks.
However, high doses or long-term usage, especially with the oral and injectable forms, can result in side effects.
Children who need steroid medications must use them under the guidance of a doctor to determine that they are used appropriately.
Why are steroids necessary?
Steroids act by reducing redness and swelling (inflammation).
They are important treatment in many common conditions, including:
- Asthma and croup
Steroids, such as prednisolone and hydrocortisone, reduce inflammation and swelling of the airways, which, if left untreated, could be life-threatening.
- Inflammatory bowel disease (IBD)
IBD comprises Crohn’s disease and ulcerative colitis.
Steroids help to control the inflammation that causes IBD flare-ups.
- Duchenne muscular dystrophy
Steroids are used to slow the progression of muscle weakness in children with this condition, and help preserve muscle strength and function.
- Autoimmune disease
In autoimmune conditions, the body’s immune system mistakenly attacks parts of the body.
Steroids help to reduce this immune response.
- Tumours and cancers
Steroids help to inhibit growth of cancer cells.
What are their side effects?
Long-term use of large amount of steroids can cause various side effects.
Hence, children who need steroid medications frequently should use them under the guidance of a doctor.
Monitoring and regular medical follow-ups are needed.
Side effects vary in severity depending on the dose, type of steroids and duration of use.
They include:
- Weight gain, a round face and increased appetite
- Stomach upset
- Mood changes such as irritability and hyperactivity
- A weakened immune system
- Cataracts.
The use of steroids can also cause disruptions to the endocrine system in the body, affecting various hormones and causing:
- Adrenal gland suppression
- A slower growth rate
- Loss of calcium from the bones, resulting in osteoporosis
- High blood pressure
- Diabetes
- Cushing syndrome.
It is important to note that not all children will experience these side effects and the severity can vary.
The above side effects listed are usually from systemic forms of steroids, i.e. oral and injections, which are given frequently.
The benefits of treatment to help the underlying medical condition must be compared with the risk of side effects.
In some conditions, corticosteroids are life-saving.
How about the inhaled form?
Inhaled steroids are essential to control asthma with persistent symptoms in children.
They are different from oral or systemic steroids because they are delivered directly to the airways, hence side effects are uncommon.
They are generally safe and effective when used appropriately.
Rinsing the mouth with water after use prevents fungal infection of the mouth.
The benefits of treatment outweigh potential side effects as uncontrolled asthma results in poor growth, and acute asthma attacks can be life-threatening.
However, the lowest effective dose should be used to control asthma symptoms and children should be reviewed regularly.
Meanwhile, nasal steroids, which are sprayed into the nose or inhaled, are commonly used to treat allergic rhinitis and nasal conditions in children and adults.
Similar to inhaled steroids, they are generally safe compared to systemic steroids because they are only used in one specific area of the body.
Absorption into the bloodstream, which goes to the rest of the body, is very little.
The benefits of using nasal steroids to control allergic rhinitis often outweigh potential side effects, which are rare.
Poor control of allergic rhinitis can affect quality of life, sleep and growth.
However, as with any medication, frequent use should go along with regular monitoring, especially in young children.
How about creams?
Steroid creams are an important treatment for eczema flare-ups.
They provide rapid relief for itchiness and inflammation (redness).
Steroid creams come in different levels of potency and are safe when used appropriately.
But care should be taken with babies and young children, who are at risk of absorbing the steroids into their bloodstream if the cream is applied in large quantities frequently.
Cases of Cushing syndrome with the symptoms of rapid weight gain, poor growth and adrenal suppression, have been reported in babies whose parents have applied steroid cream at the nappy area without medical supervision.
An important medicine
Corticosteroid medications are important treatment for many common conditions.
When prescribed appropriately, their benefits in helping the underlying condition often outweigh potential side effects.
In some conditions, steroid treatment is life-saving.
Regular medical monitoring is needed for children who need treatment with steroids to ensure efficacy with the appropriate dose and to minimise side effects.
Parents must also be cautious in giving children unregulated alternative medications or creams where the ingredients are not clearly listed, as they may contain unknown amounts of steroids.
Dr Jeanne Wong Sze Lyn is a consultant paediatrician and paediatric endocrinologist. This is the 10th article in a monthly series called Hormones and Kids. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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