Do Corticosteroids for Asthma Stunt a 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?
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.
In my medical recorts, my doctor wrote this about me:
"Rick's growth and bone development have been affected by his high steroid use. He was evaluated completely in the Pediatric Endocrinology clinic at the children's hospital. Their findings indicate Rick is constitutionally delayed in growth and his severe asthma and requirements for high-dose steroids over the past several years have contributed to this delay. Based on their information, Rick has an estimated adult height of 5 feet 6 inches. Rick also has steroid induced osteoporosis that needs to be dealt with. "
Being the worrying type I was back then, this news caused me much anxiety.
Yet my counselor assured me this was nothing to fret about.
He said, "Doctor estimations are nothing to worry about. Your main concern right now should be getting your asthma under control and the steroids are helping you with that."
A few months after I was discharged from the asthma hospital, and completely weaned off oral GCs but still on high doses of inhaled ones (4 puffs 4 times a day of Azmacort), my doctor told me I no longer had osteoporosis. But my height continued to vex me. Even as a senior in high school I had the body of a freshman.
Despite those NJH estimatinons, however, I am now 5 feet 8 inches tall.
Sure all four of my brothers are taller than me, but who cares. My current height works just great for me. If the GC shrunk me 1.1 cm, I can't tell and don't really care.
My advice to you is the same as that given to me by my counselor back in 1985: "It's better to let your doctor do what it takes to treat your asthma now than to risk worse asthma -- or even death -- down the road, even if that includes steroids."