How steroids can affect mood and behavior
Your child may be prescribed steroids, or glucocorticoids as they are medically known, for a wide variety of pediatric inflammatory or autoimmune conditions. Despite their effectiveness, these powerful medications come with a broad range of potential side effects, which can be particularly distressing for young patients and their parents or caregivers.
One of the most visible and concerning side effects of steroid use in children is a change in behavior, often referred to as 'roid rage’. This term is somewhat misleading as it conjures images of the extreme aggression seen with anabolic steroid use in athletes. However, the behavioral changes associated with prescribed steroids can lead to significant emotional instability, so it’s worth knowing what to look out for and how you can best support your child.
What does 'roid rage' look like?
As any parent or caregiver knows, it’s normal for a child’s moods and behaviors to fluctuate. However, if your child takes a high dose of steroids, it’s good to keep an eye out for particular changes. Parents might observe that their child becomes unusually irritable or starts to have mood swings that are intense and out of character - ranging from bouts of crying to uncontrollable laughter, often without any clear reason. These mood swings can develop into aggression, confusion and, in rare cases, psychosis. Fortunately, these severe reactions are not common, but when they do occur, they can be very upsetting.
Why does this happen?
Steroids directly impact the brain and can cause rapid and exaggerated changes in mood.
This can present as irritability, anger or hysterical behavior within one or two days of starting treatment, depending on your child’s dose. The exact cause of steroid impact on the central nervous system is not known, but the effects appear to be closely related to dose with greater impacts linked to higher doses. However, significant effects can also be seen in children taking lower doses, if they happen to be susceptible. It can be comforting to know that any behavioral changes you see are likely to be temporary and can usually be reversed by reducing your child’s steroid dose, under close medical supervision.
Staying informed and working closely with your child’s doctor is key to supporting your child’s health and well-being.
Top tips for parents and caregivers
Physicians generally prepare families for the possibility of these side effects, which is essential for understanding and managing them effectively.
According to Dr Paul Brogan, a professor of vasculitis and consultant pediatric rheumatologist at University College London and Great Ormond Street Hospital, awareness and education are crucial.
Dr Brogan says: “It may not be immediately apparent to parents that behavioral difficulties could be a side effect of steroids.”
He advises:
1. Monitoring and communication
Keep a log of any behavioral changes you notice and communicate these to your child’s doctor as soon as you can. You may find it helpful to use a simple scale, from '0' (no issue) to '10' (extreme problem), to help explain the severity of the situation to your child’s medical team.
2. Adjusting treatment under supervision
If severe side effects develop for your child, it’s critical to consult with your healthcare provider, do not make your own adjustments to medication. This ensures the safe and effective use of steroids with minimal risk of adverse reactions.
3. Education and reassurance
The simple fact that you understand that these behavioral changes are a potential side effect of steroids and are reversible can reassure and empower you to handle the situation with greater confidence.
“Steroids cause many side effects that can affect virtually every aspect of the human body, both physically and psychologically. If you are in any way worried that an unexplained side effect or a change has happened in your child starting steroids, please do discuss this with your physician.
“Other changes to watch out for include changes in how often they use the bathroom (to pee), which might point to steroid-induced diabetes; headaches that might point towards elevation of blood pressure, or changes in the skin. If in doubt, please discuss with your physician.”
The bottom line
While steroids remain a powerful tool in treating pediatric autoimmune and inflammatory diseases, they can have a big influence on your child’s mood and behavior and should be managed carefully to balance efficacy with safety. By staying informed and working closely with healthcare providers, you can significantly reduce risk and support the health and well-being of your child.
Remember, always consult your doctor before making any changes to your medication or lifestyle to ensure the best care for your specific health needs.