Hydrocortisone Injections for Children

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For children with adrenal disorders, getting sick can put added stress on their bodies.

If your child is on adrenal replacement therapy – including medications such as hydrocortisone, you may have received detailed instructions to give extra doses of the medicine when your child is sick.

When a child is so sick that they can’t take their medicine by mouth, an injection of hydrocortisone can be life-saving. At Children’s Health℠ we will work closely with you to answer your questions about when and how hydrocortisone injections can help your child. 

The following video, available in English and Spanish, shows how to give a shot of hydrocortisone.

  • Please utilize this video as a periodic refresher so that if or when you need to give this injection you feel comfortable doing so.
  • After administering the injection, you should call 911 or call our endocrinology office at 214-456-5959.

Hydrocortisone Injection Video - English

Hydrocortisone Injection Video - Spanish

What is a Hydrocortisone Injection?

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. It 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 in 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 in 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 to expect with Hydrocortisone Injections in 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 instructions for giving Hydrocortisone Injections to 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 in 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? 

Frequently Asked Questions about Hydrocortisone Injections in children?

How will a hydrocortisone injection help my child?

  • They are used as a hormone replacement in emergency situations for children with endocrine conditions who don't produce enough of the hormone cortisol.

How are hydrocortisone injections given to children?

  • Your provider will give you step-by-step instructions on how to set up the injection and administer it.

Where should I keep my child's hydrocortisone Injection medication?

  • Store the medication in a dark, dry place away from moisture (not in the bathroom or above the kitchen sink).

How will I know when to give my child a hydrocortisone injection?

  • If your child has a fever, vomits or experiences other illnesses that stress the body, your child may need a “stress” dose. The injectable form should be considered if your child is unable to take this stress dose by mouth.  Your provider can help you determine what is right for your child.

How often will my child need a hydrocortisone injection?

  • Only in case of significant medical emergencies.

How long does it take a hydrocortisone injection to work and how long does it last for my child?

  • The medication starts to work right away when given, but the time until a child starts to feel relief from their symptoms can vary tremendously depending on what symptoms they are experiencing and why.  Always seek medical attention after giving your child a hydrocortisone shot.

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