Worries
and Side Effects About Prednisone?
What should we worry about? Who should avoid taking
it? What are the side effects?
General Guidelines
The following are general guidelines; you must discuss
these issues thoroughly with your pediatrician and neurologist
- Prednisone severely represses the immune system,
and the high doses required for treatment cause the
body to shut down its natural production of cortisone.
Therefore, you cannot just stop giving it, The child
must be weaned off.
- Children must be under continuous medical care during
the treatment period, 4-6 months plus weaning-off
period of about 2 months.
- Children who cannot go through full regimen (e.g.,
if you will be moving overseas and are unsure of medical
accommodations) should not start until they can be
under continuous medical care.
- Children with chicken pox or other short-lived viral
diseases should not be put on prednisone until their
illness has passed.
- Some people have considered a "stealth virus"
as a cause of autism. However, no neurologists have
noted the types of reactions to prednisone that would
be expected from an undetected viral infection being
present (notably, a dramatic worsening of the symptoms
as the immune system is suppressed), so it is highly
unlikely that the "stealth virus" theory
plays a role in autism and Autistic Spectrum Disorders.
- Children who have recently had surgery should wait
until the body has fully healed.
- Children with diabetes or an underlying immunodeficiency
syndrome should not be put on prednisone.
First, note that the length of treatment (4-6 months)
is long, but not overly so -- children with severe asthma,
leukemia, epilepsy and other diseases are sometimes
on prednisone for a year or more. Therefore, the risks
from long-term use, while not inconsiderable, are controllable.
It is vital that the child be monitored continuously
to avoid problems - this includes regular urine glucose,
blood pressure and blood potassium level testing, and
continuous surveillance by the parent for any signs
of problems (e.g., a cold that won’t go away).
Short-term Effects
These short term effects that will appear during treatment
but disappear afterwards include:
- Increased appetite and weight gain (but this should
not interfere with any dietary interventions)
Cushingnoid appearance (bloating and swelling due
to water retention, as well as eating more): this
looks bad but is not harmful.
- High blood pressure, increased blood potassium,
sugar in urine: requires regular monitoring, so that
you can adjust the dosage to compensate. This is not
a high risk factor if the monitoring is done regularly.
- Bone thinning: Must assure activity and calcium,
vitamin D supplements. Calcium, magnesium, potassium,
phosphorus levels can be determined by bloodwork drawn
on a routine basis (biweekly or monthly depending
on protocol).
- Irritability, fitful sleep: not a health risk (and
actually, some children sleep better)
- Infections: If exposed to colds or other diseases,
the child must be monitored closely by his doctor
since his immune system will be suppressed. This side
effect may be critical, and the one that must be most
closely monitored. For this reason, some parents may
wish to wait until cold/flu season is over before
starting treatment.
Potential Long-term Effects
- Cataracts: Given the length of treatment and generally
young age, this is not seen as a risk. To be absolutely
safe, the child must see an opthamologist at yearly
intervals, which you should probably do anyway. For
the most unlikely but worst possible outcome, cataracts
can be corrected surgically.
- Bone loss: Generally not a factor for younger children,
but should be monitored if there are any signs of
osteoporosis or bone thinning, especially in the femur
(thigh bone). May be a problem if child was on prednisone
for long periods for other afflictions, e.g., asthma.
- Growth stunting: This is not a health risk, and
although it may be a problem with treatment periods
of greater than six months, it is generally not a
factor in current protocols. Some children actually
grow more during treatment. Some children may experience
"catch up growth" after steroids are discontinued.
Other
You cannot take child off prednisone immediately, since
it suppresses adrenal glands. Weaning takes about two
months of gradually reduced dosage. However, the adrenal
glands are not permanently affected, and they eventually
recover their normal function, although this may take
many months.
Finally, prednisone taken orally is very bitter and
tastes terrible (even when flavored - cherry works best),
and it is often a battle to get it down the kid’s
throat. Pulse doses may be given orally by pill, or
anal suppository (this is no joy either).
Questions or comments about Prednisone and Autism?
Email us at prednisone@aheadwithautism.com.
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Prednisone
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