What are the side effects of hydrocortisone in children?

October 12, 2025 •

4 min read

Corticosteroids, including hydrocortisone, are a critical component in treating many pediatric diseases, with up to 10% of children potentially requiring them at some point in childhood. A primary concern for parents and doctors, however, is understanding what are the side effects of hydrocortisone in children, which can vary widely depending on the dose, duration, and method of administration.

Quick Summary

Hydrocortisone side effects in children range from localized skin issues with topical use to more severe systemic effects like growth suppression, adrenal suppression, and mood changes with prolonged oral use. Risks are managed by doctors through careful monitoring.

Key Points

Growth Suppression: Long-term systemic hydrocortisone use can slow down a child's growth due to inhibited growth hormone and reduced bone formation.
Adrenal Suppression: Prolonged use can suppress the body's natural steroid production, potentially leading to a life-threatening adrenal crisis if stopped abruptly without a gradual taper.
Cushing's Syndrome Risk: Extended high-dose systemic or potent topical use can lead to Cushing's syndrome symptoms like weight gain, mood changes, and a 'moon face'.
Increased Infection Risk: Hydrocortisone is an immunosuppressant, increasing a child's susceptibility to infections, including severe ones like chickenpox.
Skin Thinning: Excessive or prolonged application of topical hydrocortisone can lead to skin thinning, bruising, and color changes, particularly in infants.
Mood Swings and Behavioral Changes: Irritability, anxiety, restlessness, and mood swings are common, even with short courses of systemic treatment.

Hydrocortisone is a type of corticosteroid that reduces inflammation and suppresses the immune system. It is used in pediatric medicine for a variety of conditions, from skin rashes like eczema to systemic issues caused by adrenal insufficiency or chronic inflammatory diseases. While effective, its use in children, particularly long-term, requires careful consideration of the potential side effects.

Systemic Side Effects

Systemic hydrocortisone refers to medication taken orally or via injection, where it circulates throughout the body. The side effects are often dose- and duration-dependent, meaning higher doses and longer courses of treatment carry a greater risk.

Common Short-Term Systemic Effects

Even with short courses of treatment (less than 14 days), children can experience notable side effects.

Mood and behavioral changes: Irritability, restlessness, hyperactivity, anxiety, and sleep disturbances are frequently reported.
Increased appetite and weight gain: This can occur quickly due to changes in metabolism.
Nausea and stomach upset: Vomiting can sometimes occur, particularly with higher doses.
Increased blood sugar: Blood sugar levels can temporarily rise, especially concerning for children with diabetes.

Significant Long-Term Systemic Effects

Chronic use of hydrocortisone over many weeks or months can lead to more serious and lasting health issues.

Growth suppression: This is a major concern unique to the pediatric population. Corticosteroids can inhibit the body's natural growth hormone and reduce bone formation, potentially affecting a child's final adult height. Regular growth monitoring is essential during treatment.
Adrenal gland suppression: The body's adrenal glands may produce less of their own steroids when an external source is provided. This can lead to a potentially fatal adrenal crisis if the medication is stopped abruptly. The dose must be tapered gradually under a doctor's supervision.
Cushing's syndrome: Prolonged, high-dose use can cause symptoms resembling Cushing's syndrome, including a rounded, puffy "moon face," fat buildup on the upper back and abdomen, and high blood pressure.
Weakened immune system: Hydrocortisone's immunosuppressive effects increase a child's risk of developing serious infections, including potentially deadly ones like varicella (chickenpox).
Osteoporosis: Long-term use can weaken bones, increasing the risk of fractures. This is a particular risk for children whose bones are still developing.

Topical Hydrocortisone Side Effects

Topical hydrocortisone, used for inflammatory skin conditions like eczema, generally has fewer and less severe side effects than systemic use. However, systemic absorption can still occur, especially in infants with more permeable skin, or when used over large areas or under occlusive dressings (like tight diapers).

Localized Skin Reactions

Skin thinning: Prolonged or high-strength topical use can cause the skin to become thin, fragile, and easily bruised.
Skin color changes: Lighter or darker patches may appear on the skin.
Increased hair growth: Unwanted hair growth can occur in the treated areas.
Irritation: A burning, stinging, or itching sensation is common at the application site.

Systemic Absorption Risks

As noted, infants and young children are particularly susceptible to systemic side effects from topical application. The National Eczema Association notes that excessive exposure has been linked to slowed growth and delayed weight gain in children. Iatrogenic Cushing's syndrome from potent topical steroid use has also been documented in infants.

Comparing Topical vs. Systemic Hydrocortisone Side Effects in Children

To provide a clear understanding of the different risks, here is a comparison table:


Side Effect	Topical Hydrocortisone	Systemic Hydrocortisone (Oral/Injection)
Growth Suppression	Possible, especially with high-potency use over large areas in infants.	Significant risk with long-term, high-dose use.
Adrenal Suppression	Possible, especially in young children with overuse.	High risk with prolonged use; requires gradual tapering.
Cushing's Syndrome	Rare, but documented in infants with potent topical steroids.	Common with high doses and long-term use.
Immunosuppression	Increased risk of localized skin infections.	Increased risk of serious systemic infections.
Skin Changes	Common (thinning, discoloration) at application site.	Can cause acne and fragile, thin skin generally.
Mood & Behavioral Changes	Less likely, but possible with significant systemic absorption.	Common, even with short-term use (irritability, anxiety, hyperactivity).
Metabolic Effects	Minimal unless systemic absorption is significant.	Common (weight gain, increased blood sugar).

Managing Hydrocortisone in Children

To minimize risks, it is crucial to follow a doctor's instructions meticulously:

Use the lowest effective dose for the shortest duration. For topical use, this might mean applying a thin layer less frequently.
Avoid overuse, especially on sensitive areas. Do not apply potent topical formulations to the face, groin, or underarms unless specifically directed by a doctor.
Use correct application techniques. For topical medication, avoid occlusive dressings on infants unless instructed, as this increases absorption.
Do not stop systemic medication abruptly. Tapering must be managed by a doctor to prevent adrenal crisis.
Monitor for side effects. Parents should be vigilant for changes in mood, behavior, appetite, and any signs of infection. Regular checkups are necessary for children on long-term systemic therapy.

Conclusion

While hydrocortisone is a valuable treatment for many childhood conditions, its use comes with a range of potential side effects that must be carefully managed. The severity and type of side effects are highly dependent on the medication's form, dose, and duration of use. Parents and caregivers should work closely with their child's healthcare provider to ensure that the medication is used safely and effectively, minimizing the risks while maximizing the therapeutic benefits. Open communication and regular monitoring are essential components of care when hydrocortisone is part of a child's treatment plan. For more information, the American Academy of Pediatrics provides comprehensive guidance on corticosteroid use in children.

Frequently Asked Questions

Hydrocortisone cream is generally not recommended for children under 2 years old unless advised by a doctor due to the higher risk of systemic absorption through their sensitive skin. A doctor's supervision is crucial for any topical steroid use on infants.

Yes, long-term systemic use of corticosteroids like hydrocortisone can stunt a child's growth. The risk depends on the dosage and duration of treatment, and doctors closely monitor growth during prolonged therapy.

Hydrocortisone can cause mood swings, irritability, anxiety, hyperactivity, and sleep disturbances in children. Parents should monitor for these behavioral changes, which are often temporary.

Yes, adrenal suppression is a serious risk, especially with long-term systemic use. If treatment is stopped abruptly, the body may not produce enough natural steroids, leading to a potentially life-threatening adrenal crisis. Always taper the dose under a doctor's care.

To minimize side effects, always use the lowest effective dose for the shortest duration necessary, as directed by your doctor. Proper application techniques and regular monitoring can also help reduce risks.

Yes. Oral hydrocortisone has systemic side effects affecting the whole body, such as growth suppression and mood changes. Topical hydrocortisone primarily causes localized skin reactions, but can cause systemic effects if overused or used on sensitive skin.

Signs of Cushing's syndrome include significant weight gain (especially in the torso and upper back), a rounded face ('moon face'), thinning skin, and high blood pressure. These symptoms typically appear with prolonged, high-dose therapy.