Dr Farber acknowledges the efficacy of oral corticosteroids but expresses concern regarding “significant toxicity even in short bursts.” However, examination of children requiring frequent short courses of oral glucocorticoids for acute asthma found no sustained adverse effects. A systematic review did find acute vomiting, transient behavioral changes, and sleep disturbances in 5.4%, 4.7%, and 4.3% of children, respectively, who were given a short course of an oral corticosteroid, predominantly prednisolone. However, vomiting is a formulation issue due to the extremely foul taste of some liquid formulations of prednisolone. Commercial formulations with better taste masking are available; an alternative is a crushed dexamethasone tablet given with sugar or a sweet soft food. The side effects of transient behavioral changes and sleep disturbances are annoying but neither dangerous nor universal. They need to be weighed against the behavioral effects and sleep disturbances associated with loss of asthma control. Moreover, clinical experience has found that those central nervous system effects of prednisolone are less common with methylprednisolone and dexamethasone. Although neither is available in a satisfactory pediatric liquid formulation, they can be given crushed with sweet soft food or sugar. The risk from varicella acquired during a short course of systemic corticosteroids is real and serious but avoidable with routine prior varicella immunization.