If hearing “steroids” leads to an image of a baby with big muscles, that’s not quite the effect of topical steroids. The form of steroids that pump up body builders and other athletes aren’t the same as the ones that parents use on their babies’ delicate skin.
Giving baby steroids sounds dangerous at first, but when it’s a doctor handing a parent a tube of cream with application instructions, it sounds a little less intimidating. Steroids are mixed into creams, ointments, and salves for a range of uses. Babies with eczema, rashes, and other skin conditions might receive a prescription or a recommendation for a certain blend from a doctor. Often, their conditions clear up with appropriate treatment.
However, despite topical steroids being a common solution to many infant problems, they’re not always the safest or best remedy.
Experts suggest careful handling of these strong drugs, since while they are invaluable in treating many conditions, they’re also only helpful if used correctly and safely every time. That said, parents may not know everything that they should look out for when using that innocent looking tube of cream. Here are fifteen things you need to consider before giving the baby steroids.
15 Slowed Growth With Steroids
Because steroids are often associated with bulking up and muscular growth, it might surprise parents to know that some topical steroids are associated with inhibition of growth in kids. This comes from a PubMed study that explored how kids with a specific type of dermatitis who were treated with topical steroids fared. While the fact that steroids can cause stunted growth isn’t up for debate, the study tracked participants who used a specific type of steroid cream to see whether that formulation had any effect on the kids’ collagen regeneration, an indicator of growth and aging.
The study found that a topical steroid called budesonide, which is often used in inhalers for asthma as well as in heart disease patients, appeared to cause stinted collagen turnover in the short-term. At the same time, the study also summarized its points with the caution that further study is needed.
14 Early Acne In Babies
According to the NHS, a common reaction to topical steroids is a mild allergic reaction that causes skin irritation. So not only can steroids make baby’s skin condition worse, it can also make acne start to form. In addition to whatever underlying condition or rash baby had, putting cream on might make it get worse and cause acne to erupt. Rosacea can also result from treatment, and that makes the face red and flushed.
While baby acne is relatively normal, especially in those hormone-filled few days or weeks postpartum, it’s concerning if your baby’s previously clear skin suddenly erupts in tiny zits. Still, acne isn’t usually uncomfortable or itchy to babies, so the only concern is whether it’s an allergic reaction to medicine, or whether it’s caused by something else. There’s also the concern that baby will scratch his face and have bleeding or pus from the zits.
13 Allergic Contact Can Have Lethal Consequences
For baby Isaiah’s first year of life, he experienced a painful skin condition that caused blistering and peeling so bad that people thought he had third-degree burns. People stopped the Smith family on the street to ask what was wrong with their child, and mom Stephanie spent hours running cool water over the baby’s “melting” skin, with little relief. She told the Mirror that doctors insisted the boy had eczema, but she had a feeling that wasn’t the case. Every time they saw a doctor and Isaiah was prescribed more steroid creams, or different ones, his eczema would subside, but then return even angrier.
Finally, Stephanie searched online and learned about allergies to low-dose steroids, and suspected that Isaiah developed issues with medications from birth when he had antibiotics and Ibuprofen. After the family stopped applying the steroids in favor of a homemade balm, Isaiah’s skin finally grew healthy again.
12 Prescribing Too Much Too Soon
Like the baby who almost died from continuous exposure to steroids, many children’s rashes only seem to get worse despite intervention with topical steroid creams. The main problem is that a misdiagnosis leads doctors to treat the wrong underlying issue, so the rash only intensifies. According to the Indian Journal of Dermatology, Venereology, and Leprology, when topical steroids are used inappropriately for the relief of undiagnosed or misdiagnosed rashes, it most often results in the child’s condition taking a turn for the worse.
Your doctor might be quick to assume your child’s rash stems from eczema or a food allergy, but make sure that you press for answers rather than assumptions. Request testing if possible to rule out allergens, and don’t stick with a doctor who’s in a hurry to prescribe topical steroids and rush you away with only a quick glance at your child’s skin.
11 Side Effects Can Be More Dangerous Than The Condition
The Indian Journal of Endocrinology and Metabolism described an unfortunate case where a five-month-old baby girl died because of a steroid cream. When her mother brought her to the doctor at five months old, complaining of a cough, fever, erratic breathing, and swelling on the baby’s face. Doctors diagnosed the baby with Cushing syndrome, which can cause growth retardation, muscle weakness, easy bruising, weight gain, diabetes, and impaired immune function, according to Medscape. It’s a rare syndrome in children, but steroids are one cause, and the five-month-old died from her dosage.
In reviewing her case, medical professionals found that the doctor who prescribed the steroid cream gave the mother a high-potency form, which should never have been used in a child. Parents should always double-check the package inserts for their children’s steroid creams to make sure it’s the proper dose, since even doctors make mistakes.
10 If The Diagnosis Is Not Definite
If you notice that your baby is developing a rash, whether it’s on her face, arms, legs, or even diaper area, a parent’s first instinct is to reach for a rash cream or other topical means of making baby better. But if you’re grabbing for a topical steroid cream without seeing the doctor first, you might just make things worse.
According to the Indian Journal of Dermatology, Venereology, and Leprology, starting a course of treatment before getting a confirmed diagnosis only makes it more difficult for medical professionals to make that diagnosis. Because each person- and baby- reacts to drugs differently, your baby’s skin might become more inflamed due to steroid application, or the rash might start to clear up, but only because of some other medication your infant was prescribed. So if baby starts getting rashy, see the doc before applying any medical creams.
9 Potency Problems Pose Hazards
According to the American Academy of Family Physicians, there are seven groups of topical steroid potency, ranging from high potency (group I) to low potency (group VII). There are a ton of different topical steroids available in different forms, of all different formulations including brand-name and generic. While parents might assume all topical steroid creams are the same, that just isn’t the case.
At the same time, the AAFP notes that a prescription for a name-brand steroid ointment may decrease patient compliance, because parents don’t want to use a lot of an expensive product. There are also differences in the potency of generic formulations, and not all formulations will work for all patients. Plus, high potency steroids can be dangerous for children, especially babies, because little ones have such smaller bodies and therefore lower tolerances to medicine.
8 Safe Steroids Can Spur Angry Allergies
Most steroids that doctors prescribe for topical use on babies and kids are considered safe. That’s because they are low potency on the rating scale, which dictates how strong a steroid solution is. But according to the Indian Journal of Dermatology, Venereology, and Leprology, some of the less potent steroids that are considered safe actually have high allergenic potential. That means that although the steroids are low-dose versions, they can cause kids to have an allergic reaction.
Also, some of the more potent steroids that are commonly used are also rare allergens, so parents of babies or children who are predisposed to allergies should talk to their doctor about the odds of the child having a reaction. That said, allergies to steroids are fairly rare, but that doesn’t mean it’s not something you should consider when deciding whether to give your baby steroids.
7 Microbes Might Grow
According to the Indian Journal of Indian Journal of Dermatology, Venereology, and Leprology, using steroids that are mixed into ointments can make the skin more vulnerable. Because steroids are combined with watery bases to create a spreadable ointment, skin is more likely to soak everything up. That’s good for the steroids, but not so good for any microbes that might be growing.
The Journal notes that microbial overgrowth can occur with steroid treatment, so this is something else parents need to be aware of. Lots of parents today are concerned about their babies’ guts and their microbiomes at birth, and this is a scenario where an imbalance can cause serious problems. It’s most common with high-dose steroids, but because every body (and baby) is different, there’s no telling what your baby will experience.
6 Avoid Drug Interactions
It’s common knowledge that antibacterial drugs can throw off other medications (birth control, anyone?), but those and antifungals can also disrupt the effects of steroid creams on your baby’s skin. If your child is taking medicine for a fungal or bacterial condition, check with your doctor before starting a steroid cream, even if it’s something store-bought. It’s always a smart idea to cross-check any medicines your child takes to avoid potential interactions, so don’t skip checking on the steroid cream.
Using an antifungal or antibacterial drug at the same time as topical steroid ointment can cause parents to think that the cream has resolved baby’s skin issues, only to have them return when treatment is stopped prematurely. It’s important to always finish a course of medication as directed, too, so this goes for both steroid creams and antibacterial and antifungal meds- just not at the same time!
5 Details In The Dosage
Although doctors should only be prescribing low or mid-potency steroids to children for topical use, these formulations can become dangerous when overapplied and used for extended periods. Ask your child’s doctor how much of the cream to apply, using a common measurement like “pea-sized” or “fingertip” amounts to clarify. Often, slathering on more cream won’t do any more for baby’s skin than just following the directions on the tube.
At the same time, not using enough will only draw out the symptoms longer, and you might have to re-do treatment to see any results. It’s hard to remember to consistently apply cream, especially when your baby is fussy or fighting it, but picking a time of day to add the application into your routine will help parents from skipping a dose.
4 The Need To Wean
Stopping cold turkey often isn’t a good choice for quitting anything, and that’s definitely the case with topical steroid use. As weird as it sounds, according to the National Eczema Association, suddenly stopping steroid use can cause symptoms of withdrawal. People can even become addicted to steroid creams. Withdrawal can involve burning, stinging, and bright red skin. The symptoms can often be worse than the original condition of the skin, and can leave parents wondering if the solution even helped at all.
A little boy with eczema nearly died after his condition got worse with using topical steroids, so his parents decided to cut him off of the drugs. It took nearly two years for his skin to return to normal, and the period after stopping the steroids was so excruciating that the child felt like his skin was burning off.
3 Consistency Keeps Up Results
Even as adults, many people often receive prescriptions, and then forget to take all of their antibiotic or other treatment. But for babies, especially, it’s important to finish the course of treatment. It’s no different for topical steroid use- especially when the treatment involves your infant’s reproductive parts. Often, doctors will prescribe steroid creams for girls whose labia are fused together, or boys with phimosis, which is when the foreskin on the penis becomes too tight.
Following the directions and being consistent with applying the cream will reduce your baby’s chances of having to have painful surgery that carries the risk of prolonged bleeding and infection, like circumcision. Applying a steroid cream daily according to your pediatrician’s recommendations will help loosen and soften the skin, and while remembering to apply it is inconvenient, it’s easier and more pleasant than cleaning out an open wound that sits inside a diaper.
2 Thinning Baby’s Skin
Parents on many online forums get together to discuss their children’s reactions to topical steroids, from beautifully clear skin to angry welts from allergic reactions. But one common thread in children who need topical steroids to clear up skin conditions is thin skin where the creams are applied. An article from the Indian Journal of Dermatology explained that topical steroids affect both internal systems of the body, as well as the outer layers of our skin.
The scientific process is hard to digest, but steroids cause three phases of skin changes- preatrophy, atrophy, and tachyphylaxis. Atrophy causes burning, and continuing to use the steroids makes the skin react to protect itself. This involves making blood vessels more dilated, so they’re closer to the surface of the skin. This not only looks bad, but it’s damaging to the skin’s protective properties.
1 Diaper Dermatitis Destroys Skin
While babies with eczema and other skin conditions might end up with rashes all over their bodies, nearly all babies experience plain old diaper rash at least once in their infancy. But did you know that if you attempt to treat diaper rash, also called diaper dermatitis, with topical steroids, it could make the infection worse?
The Indian Journal of Dermatology explains that there are four different cutaneous (skin) infections that get worse when topical steroids are applied to them. The images for these rashes are not pleasant- almost like a cross between angry red stretch marks, acne, and a bruise. This unfortunate reaction is just another reminder to be careful of where you apply steroid cream, and ensuring that your child receives a proper diagnosis before starting any treatment.
Sources: Indian Journal of Endocrinology and Metabolism, Medscape, Indian Journal of Dermatology, Venereology, and Leprology, National Eczema Association, NHS, AAFP, Mirror, PubMed, Indian Journal of Dermotology