Laura,

 

In my opinion, each one of these meds can be successfully used in either children or adults, as long as the treating physician is experienced with the particular medication.  But, that is a big “IF.” 

 

I think one of the reasons why hydrocortisone is more commonly used in children and prednisone/dex more often in adults is a purely practical one…children are smaller and generally need smaller doses.  So, you need to give them a medication that comes in increments small enough to match the needs of the child.  For example, dex pills come in 0.25 mg and 0.5 mg strengths.  These days, the 0.25 mgs are difficult to find, so you are basically stuck with a 0.5 mg pill.  Each one of these teeny weeny pills (they are about half the size of Cortef tabs) contains the equivalent of 40 mgs of hydrocortisone.  Obviously, that is much much more than a baby would need at one time.  Breaking the pills in half still leaves you with the equivalent of 20 mgs in one dose…still way, way too much.  The pill problem goes away when a liquid is used, but many physicians seem to be unfamiliar with the liquid dex or liquid prednisone, so appear reluctant to prescribe it. 

 

It has also been suggested that some children may metabolize meds more quickly when they approach puberty.  So, the natural solution would be to switch them from a short acting med (such as hydrocortisone), to a longer acting med (such as prednisone or dexamethasone).  Of course, the high metabolism issue can theoretically be addressed by giving more frequent doses of hydrocortisone, but then you run into the other practical issue of a person remembering to take four or five doses a day, every day…which is difficult for most people.  Yet, medication is only effective if one remembers to take it.    

 

Lastly, I also think doing things in certain ways has a lot to do with people wanting to stick with what they know or what they believe is tried and true.  In other words,  “that’s the way it’s always been done.” Change is (understandably) scary to a lot of people, especially if it takes a while to work out the kinks involved in learning a new system.  I think a lot of people (doctors included) often feel safer sticking to the status quo, even if the status quo is imperfect. 

 

Anyway, my two (or three!) cents…(aren’t you glad you asked!!! haha!!)