Children who need to take oral steroids for chronic or life-threatening conditions can experience serious side effects, according to new research.
Children with autoimmune disorders such as juvenile arthritis, psoriasis or inflammatory bowel disease are often prescribed a steroid to keep the illness under control.
But the odds that a child might develop diabetes was nearly six times higher in children taking steroids than in those who don’t. The odds of high blood pressure was 19 times higher in those on steroids, and the likelihood of a blood clot was 16 times higher, the study found.
The good news, however, is that these complications are all exceedingly rare.
“These complications are serious but rare. They affect a very tiny proportion of children with steroids,” said study author Dr. Daniel Horton, an assistant professor of pediatrics and epidemiology at the Rutgers Center for Pharmacoepidemiology and Treatment Science in New Brunswick, N.J.
Horton pointed out that doctors are aware of the many side effects related to steroids, but they also know how much good the drugs can do in certain situations, such as asthma or autoimmune conditions.
“When I prescribe this medication, the benefits must outweigh the risks or I wouldn’t prescribe it. This study shows the kinds of complications that doctors need to look out for, particularly if a child receives high doses of an oral steroid like prednisone,” Horton said.
The study included more than 930,000 U.S. children up to age 18. Some had autoimmune diseases and some didn’t. Many of the youngsters (about two-thirds) with autoimmune diseases who were also given steroids showed evidence of asthma, too.
The researchers didn’t look for all types of complications linked to steroids. They searched for diabetes, high blood pressure and blood clots. High blood pressure was the complication that occurred most in children taking steroids.
All three complications were more common in children with autoimmune diseases, whether or not they were taking steroids.
Horton said this study wasn’t designed to prove a direct cause-and-effect link. It only found an association. But, he added, “The results were fairly robust in a large population, which suggests a real effect of these medications.”
The effect of steroids in the body is complex, Horton said. Some ways they act in the body are disrupting metabolic activity and increasing direct hormonal effects on the heart and blood vessels. Steroids are also known to cause weight gain.
Dr. Robert Pass is division chief for pediatric cardiology at Mount Sinai Kravis Children’s Hospital in New York City. He was not part of the research, but reviewed the findings.
“This study reinforces the known idea that steroids can cause or enhance the risk of diabetes, high blood pressure and blood clots. But, for most children taking oral steroids, there are not many alternatives,” Pass said.
“In children with very bad asthma, use of oral steroids is a mainstay. You don’t want to miss out on the benefits of oral steroids when needed. If used properly, steroids can be administered safely,” he said.
Pass said the study points to the ongoing need for alternative therapies. But he added that parents don’t need to be frightened if their child needs a steroid. He suggested speaking with the child’s physician about the decision to put the child on a steroid.
And, both doctors said, whenever possible, steroid-sparing medications are chosen. Nutrition counseling may help avoid some of the weight gain that can occur with steroids, Horton said.
The study was published recently in the American Journal of Epidemiology.
Learn more about prednisone, a commonly prescribed oral steroid, from the U.S. National Institutes of Health.
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