Steroid Medicines and Behavior

Steroid medicines are used in many treatments for cancer, sickle cell disease, and other illnesses. Doctors may prescribe these medicines to:

• Relieve inflammation (heat, swelling, redness, and pain)
• Prevent graft–versus-host disease (GVHD) after stem cell (bone marrow) transplant
• Treat severe allergies, asthma, nausea, vomiting, and certain cancers

Steroid medicines can be very important to your child’s care. But steroid medicines do have side effects. These can include changes in your child’s behavior, emotions, and thoughts.

How steroids might affect your child

• Behavior - Your child might act differently. Common changes include angry outbursts, restlessness, and crying more than normal. Also, your child may act very energetic or hyperactive.
• Mood and emotions - Your child might seem angry, irritable, depressed, or anxious. You may see mood swings, where your child’s emotions change quickly and often.
• Thinking - Your child might get confused easily or have a hard time remembering things. Your child might also be distracted more easily or have trouble concentrating.
• Sleep - Your child might have sleep problems. Your child might find it hard to go to sleep or stay asleep.
• Senses - Your child might see or hear things that are not there.

These changes can be seen in children of any age. Even infants and toddlers may show these symptoms, including sleep problems, irritability, and crying uncontrollably.

How to help your child

First, stay calm. Remind yourself that the changes you see are a temporary side effect of your child’s medicine.

Here are some ways to help your child cope:

• Ignore minor problems.
• Avoid big changes. Keep your child’s surroundings and schedule as normal as possible.
• Give your child time to calm down. Provide a quiet place if needed.
• Encourage your child to do deep breathing and other relaxation activities.
• Comfort your child if they cry or seem sad.
• If your child notices the changes, talk about how medicines can affect people in different ways. Involve your child in planning ways to cope.

For some children, there may be nothing that seems to help with these mood and behavior changes. We often call this inconsolability. If this is happening to your child:

• Talk to your child’s care team. They can help but may not know how bad these changes are unless you tell them.
• Try not to feel ashamed or embarrassed if you can’t calm your child. If these changes are related to steroids or another medicine, they may need medical treatment.
• Set limits for your child, such as ‘no hitting’. But try not to blame or punish them for these mood and behavioral changes.
• Coping with steroid related mood changes can be very hard for families. Please talk to your child’s care team if you are feeling overwhelmed.

Psychosocial services

Tell your child’s care team about any changes you notice in your child’s behavior, emotions, or thoughts. You also can ask for help from psychology or psychiatry services at your treatment center. If your child already saw someone from these areas, make sure your child’s doctor knows about the care your child has received.

Getting help from psychology or psychiatry services does not mean your child is mentally ill. It also does not mean they will always need mental health care. These services can help behavior, emotional, or thinking problems in specific ways.

• Psychology staff members can look for ways to manage problems caused by steroid medicines. They might teach you specific ways to cope with the changes and give ideas on how to calm or comfort your child.
• Psychiatry staff members may prescribe medicine to help with side effects. They also can help your child’s other doctors to manage medicines that affect behavior, emotions, and thinking.
• Other services such as child life, social work, spiritual care, and music therapy can also help your child develop coping skills and find ways to express thoughts and emotions.

Find more information on Psychology and Mental Health Services.

Be sure to let your care team know about any side effects your child has when taking medicines. Always read the medicine label and follow dosing instructions carefully. Do not start or stop any medicine without talking to your doctor.