Short-Term Corticosteroid Use Linked to Hyperglycemia, Sleep Issues, and Rare GI Bleeding Risks Among Children: JAMA
Canada: Short-term use of systemic corticosteroids in children and adolescents may increase the risk of certain adverse events, particularly hyperglycemia and sleep disturbances, a systematic review and meta-analysis recently published in JAMA Network Open has found.
The review, led by João Pedro Lima from McMaster University’s Department of Health Research Methods, Evidence, and Impact, and colleagues, analyzed evidence from 45 randomized clinical trials including 6,470 participants aged 1 to 17 years. While corticosteroids are frequently prescribed for acute conditions such as croup, pneumonia, and Bell’s palsy, concerns about their safety in pediatric populations remain, especially when used for short durations of 14 days or less.
Key Findings:
- Corticosteroid use was generally not linked to serious adverse events, hospitalization, or treatment discontinuation.
- Moderate-certainty evidence showed an increased risk of hyperglycemia in children receiving corticosteroids, with 38 additional cases per 1,000 children.
- Corticosteroid use was associated with more sleep-related problems, with 15 extra cases per 1,000 children.
- A possible association with gastrointestinal bleeding was observed, with 13 more cases per 1,000 children, though the certainty of evidence was low.
- Behavioral changes were reported in some cases, but the link was not statistically strong.
The authors emphasized that although adverse events were observed, they were generally mild and seldom severe. This suggests that while corticosteroids remain a valuable therapeutic option in many pediatric conditions, clinicians should carefully weigh the benefits against potential risks, tailoring decisions to each patient’s clinical profile.
The review also highlighted important limitations. Many of the included trials did not focus primarily on adverse event reporting, leading to inconsistencies in how side effects were defined and documented. Gastrointestinal bleeding, for instance, was not categorized by anatomical site, making further analysis difficult. The possibility of underreporting adverse events was also acknowledged, raising the concern that actual risks may be underestimated.
According to the authors, the findings underscore the importance of individualized treatment decisions when prescribing short-course corticosteroids in children and adolescents. They also called for further high-quality research to strengthen the evidence base, particularly for less frequently reported outcomes such as gastrointestinal bleeding and behavioral changes.
The systematic review and meta-analysis provide important insights into the short-term safety profile of corticosteroids in pediatric populations. The evidence indicates an elevated risk of hyperglycemia and sleep disturbances, with possible though less certain links to gastrointestinal bleeding. While these adverse effects were rarely serious, the findings highlight the importance of close monitoring and careful patient selection.
The authors recommend that future trials and reviews focus not only on corticosteroids but also on other commonly used drug classes in children, alongside developing better methodological standards for adverse event reporting.
Reference:
Lima JP, Chowdhury SR, Tangamornsuksan W, et al. Adverse Events Following Short-Course Systemic Corticosteroids Among Children and Adolescents: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2025;8(9):e2534953. doi:10.1001/jamanetworkopen.2025.34953
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