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Column originally published Oct 25, 2016

Is Steroid Harmful For Children?

Question: Our four-year-old son is always sick; he gets one cold after another. He has a constant running nose even when he is not sick. When he gets a cold, he gets much worse and coughs for weeks. He has been treated with antibiotics, which didn’t help much. Several weeks ago, he coughed so much that he couldn’t breathe. He was admitted to hospital for over a week. He was treated with IV steroid, with masks and puffers every hour for many days. It was scary to see him being so sick. He is much better now, and he hardly coughs. The doctor told us that he needs to stay on the steroid puffer for a long time. I am worried about steroid’s side effects. Please give us your advice.


It is difficult to see your son being so sick. I hope your doctor has told you that he most likely has asthma, which explains his recurrent illness and hospital admission.

Asthma is an inflammatory condition of the lungs. Children can be allergic to environmental triggers like dust mites, moulds, and animal danders. The bronchial tubes in their lungs are swollen and filled with mucus, which lead to coughing, wheezing, and difficulty breathing.

When they get sick with a cold, the inflammation gets worse, with tightening of the bronchial tubes which are clogged up with mucus. Their cough gets tighter and can sound croupy. Sometimes, they can cough and vomit up mucus. They breathe faster than usual; there can be indrawing between the ribs. Their problem is often worse at night and when they run. Colds tend to last longer than other children; one cold may not completely resolve before the next cold hits.

The same thing can happen to their nose, with swelling of nasal mucosa and drainage. This can lead to complications like sinus and ear infections.

The most effective treatment for asthma is steroid, it reduces inflammation in the bronchial tubes. When he was very sick, steroid had to be given through an IV. Other children who are less sick can take it orally, usually for a few days.

Inhaled steroid is even safer. It can be given through a puffer. For a young child, he will need to have a chamber with a face mask for him to take the medicine. As a result, only a very small fraction of the steroid gets into his lungs. It is perfectly safe to use steroid puffer once or twice a day for asthma prevention, even for months or years. It is much safer for him to use inhaled steroid to keep asthma under good control instead of getting sick and has to use IV or oral steroid.

You can also discuss with your doctor about another prevention medicine called montelukast (Singulair). It is a chewable pill that needs to be taken daily to prevent asthma. It is not a steroid; it can help to reduce the severity of asthma, therefore, reduce the amount of inhaled steroid that he needs.

Another important step is to reduce environmental triggers in your home. Many hospitals and your local Lung Association should have educational material that can assist you to improve your home environment.

With a combination of medication and trigger reduction, your son’s asthma can gradually improve. When he gets a cold, you can increase his inhalers at home so that he can recover quickly, like all other children who don’t have asthma.