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Side-effects of steroids

As with many medications, steroids affect different people in different ways. Their effect will also depend on the type and dosage of steroid prescribed for your child.

Please remember your child should NOT stop taking steroids without advice from their doctor.

Common side-effects of steroids in children

You should talk to your child's doctor about any side-effects they experience. Some of the common side-effects of steroids are:

Increased appetite

It is fairly common to feel hungrier than usual when you are taking steroids. Eating more will obviously lead your child to gain weight. If this happens, it can be very distressing for your child.

It may be helpful to give them filling, but low calorie, foods, such as vegetables. You could also try serving smaller portions.

Some children who have been taking steroids and gained weight prior to treatment, find they lose the weight during treatment, as chemotherapy, radiotherapy and the anaesthesia used in surgery can cause nausea, vomiting and loss of appetite.

Once your child stops taking steroids, their appetite will return to normal and they should gradually lose the excess weight. Teenagers sometimes find it more difficult to lose the weight they have gained. This too can cause them much anxiety.

If you are concerned about your child's weight gain, speak to their doctor for advice.

Difficulty sleeping

Some children may find it difficult to sleep when they are taking steroids. Let your child's doctor know if this happens. They may prescribe medication that helps to calm your child before bedtime.

Alternatively, they may suggest that your child takes the steroids early in the day to minimise disruption to their sleep pattern.

It can be helpful to get into a routine before bedtime, perhaps giving your child a warm drink and switching off the TV, computer, iPad etc to help them calm down and relax.

Be sure to speak to your child's doctor before making any changes to their medication schedule.

Irritation to stomach lining

If your child is taking steroids in tablet form, they will need to take them with food or milk to help prevent irritation to the stomach lining, that can cause stomach ulcers.

Your child may have indigestion or heartburn after taking steroids tablets. Your child will usually be given anti-acid medicine with the steroids to prevent this, but let your doctor know if your child develops these symptoms.

Candidal infection in the mouth (oral thrush)

This can often happen with steroid treatment. Keeping a close eye on your child's mouth can help in spotting this early and getting it treated by your child's doctors.

Changes to blood sugar levels

If your child feels thirstier, or needs to wee, more often, you should speak to your child's doctor promptly as these symptoms could suggest that your child's blood sugar levels have temporarily risen.

If their blood sugar level remains high, some children may need to have insulin for a time. However, their blood sugar level will usually go back to normal once the steroid treatment is completed.

During the course of steroids, your child's blood sugar levels will be monitored via blood tests.

If their blood sugar level remains high, some children may need to have insulin for a time. However, their blood sugar level will usually go back to normal once the steroid treatment is completed.

During the course of steroids, your child's blood sugar levels will be monitored via blood tests.

Water retention

Your child's hands and feet may swell, because their body is not getting rid of fluid. To help reduce the swelling, encourage your child not to stand in one place for too long and to avoid crossing their legs.

It is also useful if they raise their feet when they sit or lie down.

Following a low salt (sodium) diet can also help, but check with your child's doctor before making any changes to their diet.

Skin thinning

If your child is taking steroids for a long time (i.e. for more than a few months), their skin may feel thinner and they may bruise more easily. It can be quite shocking to see your child with more vivid bruises from normal childhood rough and tumble.

Skin thinning is an uncommon, temporary side-effect of steroids. Speak to your child's doctor, who may lower the dose of steroids. It generally disappears once the dosage is lowered.

Muscle wasting

With long-term use of steroids (more than a few months), your child's legs may feel weaker.

When the steroids are stopped, some people may have muscle cramps for a short time.

Greater chance of infection

Steroids can make your child more likely to catch infections as they restrict the way their immune system reacts to viruses and bacteria. You may be able to help your child avoid infections by encouraging good hygiene, such as hand washing and being extra vigilant.

Let your child's doctor know if you notice any signs of infection in your child, such as:

  • temperature above 37 degrees C
  • redness or soreness
  • wounds taking longer than usual to heal.

If necessary, they will be given antibiotics to help fight the infection. It can be particularly worrying when childhood diseases, such as chickenpox and mumps, are going around their school.

Inoculations

Chickenpox is often more severe in children who are having steroid treatment due to their reduced immune response. Most treatment centres will test newly diagnosed patients to see if they are immune to chickenpox. You can ask your child's health team for the results or, if it hasn't been done, if it needs to be.

If your child has a definite contact with chickenpox i.e. sits/plays with someone, who develops chicken pox, in the 72 hours (3 days) before the spots come out, they may be given antibiotics or an injection of antibodies against chickenpox. Let your child's health team know as soon as there has been contact.

Their brothers and sister can also be offered immunisation to protect against chickenpox. This reduces the risk of them catching it and passing it on to your child. Discuss this with the team looking after your child.

As your child's immune system may be lower when they are taking steroids, they should not be given 'live' vaccines. These are injections that contain a small amount of a living bacteria or virus that has been made weaker in the laboratory.

Examples include:

  • MMR (measles, mumps and rubella)
  • BCG (which protects against tuberculosis).

Effects on growth

If your child is taking a high dose of steroids for a long time, it can affect their growth. Your child's health team will keep a check on them throughout the course of the steroid treatment to make sure that any such effects are minimised.

Effects on the eyes

If your child has to use steroids for a long time, it can lead to increased pressure in the eyes (known as 'ocular hypertension'). This high pressure can damage parts of the eye vital for vision, such as the optic nerve.

Often the person is not aware of this increased pressure, as there are no early symptoms. If left untreated, it can result in 'glaucoma' - a gradual, but permanent, loss of vision beginning at the outer field of vision ('peripheral vision').

For this reason, it is important to take your child to the opticians regularly, to monitor for any signs of these side-effects.

Increased eye infections and delayed healing of the surface of the eye are also a common side-effect of steroid usage.

Emotional effects

Emotional effects are common with steroids. Your child may feel anxious, irritable and more emotional while taking steroids and for a while after stopping.

You may find that they display behaviours of a younger child (for example, temper tantrums) or you may notice that they show 'hyper' moods and find it difficult to relax and sit still.

Some parents feel guilty for feeling frustrated or getting cross with their child, but it is important to recognise that this is a very difficult time and such feelings are natural.

As with all side-effects, speak to your child's doctor about any such changes in your child. They may be able to involve a psychologist to help you and your child develop ways of coping with this.

Coping with emotional and behavioral effects

The emotional and behavioural side-effects that steroids may cause can be difficult to cope with, but it is important that your child takes the steroids to reduce swelling and relieve pressure on their brain.

You may find the following practical suggestions helpful:

  • let your child burn off excess energy - for example by running about in the garden or park. This can help to reduce 'difficult' behavior caused by having too much energy (hyperactivity) and boredom
  • keep a diary of your child's mood swings - this may help you to see if there is a pattern and help you with planning certain activities, for example, family outings. It may also be helpful to talk to your child about the effect of their moods that steroids can have - it may help them to understand why they feel like this and make their mood swings slightly easier to cope with
  • be aware of the effects mood swings may have on brothers and sisters - for example, they may be on the receiving end of emotions such as anger and agression. It may be a good idea to keep an eye out for this, and, depending on the age of their brothers and sisters, explain to them that medication can have an effect of mood. This will help them to understand
  • discuss any difficulties with your child's health team - they may have useful suggestions, for example, changing the timings of doses to encourage a more peaceful night's sleep
  • join our Parents Facebook Group - this is a closed group where parents of children with brain tumours can discuss issues with people going through the same thing. The group is very supportive and people often have useful suggestions based on their own experience.

If you have further questions, need to clarify any of the information on this page, or want to find out more about research and clinical trials, please contact our team:

Information and Support line

0808 800 0004 (free from landlines and mobiles)

support@thebraintumourcharity.org

Phone lines open Mon-Fri, 09:00-17:00

You can also join our active online community on Facebook - find out more about our groups.

What are steroids?

Jake explains what it is like to take steroids for a brain tumour.