Avoid administering systemic steroids to young children with respiratory symptoms except for moderate/severe laryngitis and acute bronchopulmonary obstruction with strong suspicion of atopic asthma

Rationale:

Systemic steroids (tablets, dispersable tablets, injections) are frequently prescribed for children with lower respiratory tract infections. However, due to lack of efficacy and potential side effects, their use should be restricted to:

1. Acute laryngitis: for moderate or severe airway obstruction, primarily to reduce hospitalization risk.
2. Acute bronchopulmonary obstruction: in young children with significant symptoms where atopic asthma is strongly suspected.

Systemic steroids should not be used for bronchiolitis or virus-induced obstruction without suspected atopic asthma. Parents should not be given systemic steroids for home treatment. 

References:

• Øymar K, Mikalsen IB, Nag T, Halvorsen T, Crowley S. Systemiske steroider til førskolebarn med symptomer fra nedre luftveier. Tidsskr Nor Laegeforen. 2017;137:698-699.
• Bjornson CL, Johnson DW. Croup in children. CMAJ 2013; 185: 1317 – 23.
• Russell KF, Liang Y, O'Gorman K et al. Glucocorticoids for croup. Cochrane Database Syst Rev 2011; 1: CD001955.
• Deshpande DR, Martinez FD. The dilemma of systemic steroids in preschool children with recurrent wheezing exacerbations. Pediatr Pulmonol 2016; 51: 775 – 7.
• de Benedictis FM, Attanasi M. Asthma in childhood. Eur Respir Rev 2016; 25: 41 – 7.