Clinical Pathway for the Child at Risk for HPA Suppression:
Stress Steroid Dosing and Weaning Recommendations
Goals and Metrics
Patient Education

Child at Risk for HPA Suppression

Meets Definition of Chronic
Glucocorticoid Therapy

  • Emergent/Critical Dosing Required
  • Based on Patient Condition
  • Length not immediately available
  • Use Hydrocortisone IV, IM
  • Severe Stress ONLY
  • Age 0-24 months: 25 mg
    Age 25 months-10 years: 50 mg
    Age > 10 years: 100 mg
Determine if Severe or Moderate Stress
Based on procedure, severity of illness
Stress Dosing Recommendations: Key Concepts
Chronic GC Therapy with
Prednisone/Prednisolone/
Methylprednisolone
Chronic GC Therapy with
Dexamethasone
Chronic GC Therapy with
Hydrocortisone
Stress dose is based on patient's current maintenance dose
Give daily dose of dexamethasone and ADD stress dose hydrocortisone
Hold daily dose and give
stress dose
Duration of Stress Dose Steroids and
Indication for Stress Dose Weaning
Indications/Dosing for Weaning Below
Physiologic Steroid Doses
Length of Stress Dose Precautions and HPA Axis Evaluation after Discontinuation of Steroids
Case Examples:
Determining Stress Level Weaning Glucocorticoids
Posted: September 2014
Revised: May 2016, June 2018, October 2019, April 2021, October 2021
Authors: S. Burnham, MD; M. Vogiatzi, MD; J. Zook, PharmD; M. McLoughlin, CRNP; C. Jacobstein, MD; V. Srinivasan, MD; H. Zhang, MD; L. Bevington, RN; R. Grundmeier, MD; J. Chuo, MD; L. Utidjian, MD; K. Lord, MD; E. Smith, RD; S. Weston, RD