A concern for Parents of Asthmatics: Will Corticosteroids stunt my child's growth?

So, your son or daughter has been diagnosed with asthma, and his or her doctor has prescribed systemic glucocorticosteroids (GC) like prednisone, and long-term inhaled GCs like Flovent or Pulmicort.  Your concern is:  Will this stunt my child's growth?

This is a great question.  In fact, according to "Allergy & Asthma: Practical Diagnosis And Management" by Massoud Mahmoudi, growth suppression is one of the top concerns of doctors caring for child asthmatics who need GCs. 

According to Mahmoudi, "Regular daily therapy, frequent short courses, or high-dose alternate-day (systemic) GC therapy often results in the suppression of linear growth.  Doses of prednisone as small as 0.1 mg/kg administered daily for a short a period as 3 months have resulted in significant suppression of linear growth."

Complicating that, Mahmoudi writes, is the fact that asthma itself -- especially poorly controlled asthma -- has been shown by various studies to stunt growth. 

Sometimes doctors don't have a choice, and if systemic GC are needed long term, a dose of 20mg or less on alternate days seems to be, according to studies, a safe dose with limited effect on growth.

Now, what about those highly recommended steroid inhalers your child is on?  Do these stunt growth too? 

When I was a child, hardluck asthmatic growing up in the 1980s my doctors would tell me to stop taking my inhaled GC when I was feeling well for fear of side effects (I wrote about this here). 

Later research, however, confirmed that not only are inhaled GCs safe, they are the most effective means of managing asthma. The catch here is this:  you have to make sure your child rinses his or her mouth out really well after each use.

That aside, Mahmoudi writes that an extensive study on this subject was performed by the Child Asthma Management Program (CAMP) in 2000 that showed children who took 200 micrograms of Pulmicort twice daily were 1.1 cm shorter than those who took a placebo (1 cm is about the diameter of a AAA batter, do give you a visual reference). Thus, the conclusion of the study was that "GC therapy can result in a modest but transient effect on growth that is unlikely to have any adverse effect on adult-attained height."

Another study followed children who were using 412 micrograms of Pulmicort for 9.2 years, and the "investigators found no difference in the measured versus the expected adult heights in any of the groups studied... Of interest, they too noted a transient suppression of growth... but it did not adversely impact adult-attained height."

I have my own personal story regarding GC induced growth suppression.  When I was an asthma patient at National Jewish Health (NJH) back in 1985 my doctor told me all the systemic GC I was on had already effected my height. While I was 15, my bone age was 13.5 years.