Hydrocortisone injections for children

What are hydrocortisone injections for children?

Hydrocortisone itself is a special class of steroid known as a glucocorticoid. Although it has many uses, for children with adrenal disorders, it is most commonly prescribed if your provider is concerned that your child does not make enough of a naturally produced hormone called cortisol. Cortisol plays a vital role in many bodily functions.

Cortisol helps to maintain normal levels of:

• Blood sugar

• Blood pressure

• Inflammation

• Metabolism

• Salt/water balance

• Sleep cycles

A healthy child makes a small amount of cortisol all day long, and even more anytime they are sick or stressed. Because your child’s body makes extra cortisol when they are sick, a child with adrenal insufficiency has to be given extra doses of hydrocortisone (or synthetic cortisol) anytime they are physically stressed. Most commonly, that extra steroid dose can be given my mouth. But in certain emergency situations, when a child can’t take medication by mouth, it has to be given via injection into the muscle.

What are the benefits of hydrocortisone injections for children?

Hydrocortisone injections raise the level of the hormone cortisol when the body doesn’t produce enough in emergency situations.

They can play a role in the treatment plan for children with many different endocrine conditions, all of which have in common a decreased ability to produce cortisol from one’s adrenal gland.

• Addison’s disease - Also known as primary adrenal insufficiency, most commonly thought to be due to autoimmune processes.

• Adrenoleukodystrophy (ALD) - Rare metabolic disorder and genetic disease most commonly affecting boys. This disorder damages nerves in the brain, leading to physical and mental disabilities.

• Congenital adrenal hyperplasia (CAH) - Rare genetic disorder affecting the adrenal glands that can interfere with sexual development and the body’s ability to produce cortisol and other adrenal hormones.

• Pituitary lesions - Abnormal growth (tumor) in your pituitary gland that affects pituitary hormone production. The hormones which control the adrenal gland’s production of cortisol come from your pituitary gland, so pituitary problems often are associated with adrenal problems as well.

• Septo-optic dysplasia - This condition can cause a child to have an underdeveloped pituitary gland, affecting the production of many hormones throughout the body.

What are the side effects of hydrocortisone injections for children?

Since it is meant to be a one time dose, given in an emergency situation, if it is given safely and with proper technique, the risks of injectable hydrocortisone are minimal.

Any injection can be associated with any of the following side effects:

• Severe pain at the injection site

• Tingling or numbness

• Redness, swelling, or warmth at the injection site

• Drainage at the injection site

• Prolonged bleeding

• Signs of an allergic reaction (difficulty breathing or facial swelling)

Because the injectable medicine is a big dose of hydrocortisone, it can also cause temporary increases in your blood pressure or blood sugar levels. If you have any concerns about the side effects, talk with your provider.

If your child is on chronic hydrocortisone (or other steroid) therapy, speak to your child's provider about carrying an injectable form of hydrocortisone in case of medical emergencies.

What can I expect with hydrocortisone injections for children?

Hydrocortisone injections come as a powder to be mixed with liquid diluent. Your health care provider will give you step-by-step instructions on how to mix and administer the injection. You will also receive instructions on when to give the dose. A copy of these sick day protocols should also be shared with your child’s school. Make sure to tell your provider if you need to administer a stress dose.

What are the prep instructions before hydrocortisone injections for children?

Before:

1. Wash hands with soap and water.

2. Gather supplies:

   • Act-O- Vial®

   • Alcohol pad

   • Band-Aid®

   • Injection needle

   • Syringe

3. Check the expiration date.

Prepare the medication:

1. Mix medication by pushing down firmly on Act-O-Vial. Force the rubber stopper into the bottom chamber.

2. Turn the vial upside down until liquid clears. Do Not Shake!

3. Prepare the injection site with an alcohol pad.

4. Remove the plastic tab from Act-O-Vial to reveal the rubber stopper.

5. Clean the rubber stopper on Act-O-Vial with an alcohol pad.

6. Connect the needle to a 1-mL syringe.

7. Remove the needle cap and insert needle through the middle of the rubber stopper on Act-O-Vial.

8. Turn the vial upside down so needle points towards the ceiling.

9. Keep the needle tip below the liquid level.

10. Plunge down slowly to draw the correct dose to the syringe.

11. Remove the needle from vial.

Injection:

1. Use quick and straight motion to insert the needle into the muscle. The typical injection site is on the outer part of the thigh because it is free of large blood vessels and nerves.

2. Press on the plunger until all medication is administered.

3. Use a quick and straight motion to remove the needle.

4. Put a Band-Aid on the site.

5. Dispose of the needle properly.

What questions should I ask my provider about hydrocortisone injections for children?

• What illnesses may prompt the need for a hydrocortisone injection?

• What fever temperature is a concern?

• How is the hydrocortisone dosage determined?

• How often can a hydrocortisone injection be administered?

• Do I keep medication at home in case it’s needed in an emergency?

• Where should I keep the medication?

• How should I dispose of the needle and unused medication?

• Are there any drug interactions with hydrocortisone injections?