Steroid Safety, Growth Concerns, and When to Escalate Pediatric Therapy

Repeated or chronic use of topical and systemic corticosteroids in children raises valid concerns about metabolic effects, mood changes, Cushingoid features, and growth suppression. Autumn Atkinson, MD, associate professor in the Department of Pediatrics at McGovern Medical School at UTHealth Houston, notes that families frequently ask about the impact of steroid exposure on long-term growth and health. She advises limited-duration use, clear stop rules, and reevaluation when increasingly frequent steroid courses are required.

Adelaide Hebert, MD, professor and director of pediatric dermatology at McGovern Medical School at UTHealth Houston, outlines clinical scenarios in which escalation to systemic biologics or oral Janus kinase inhibitors is appropriate, particularly in adolescents with severe, refractory disease or impaired quality of life. She notes that effective control of systemic inflammation may support catch-up growth and relies on pediatric colleagues to identify concerning growth trends. Hebert also emphasizes that newer topical agents have demonstrated no adverse effects on growth or infection risk.

In this segment, Hebert and Atkinson integrate dermatology and general pediatrics perspectives on balancing rapid symptom control with long-term safety. They advocate for steroid-sparing topicals as foundational therapy, reserving systemic steroids for narrowly defined indications, and engaging families in informed decision-making when advanced systemic therapy is warranted.