A nurse is reinforcing teaching with a parent of a child who has a new prescription for a budesonide inhaler. Which of the following adverse reactions should the nurse include in the teaching?

Budesonide is an inhaled corticosteroid used in the management of asthma and other respiratory conditions. One of the most common and clinically significant adverse effects of inhaled corticosteroids is oral candidiasis, a fungal infection of the mouth and throat caused by residual corticosteroid depositing on oral mucous membranes, which suppresses local immune defenses and allows Candida overgrowth. Parents should be taught to have the child rinse the mouth with water and spit after each use of the inhaler to reduce this risk. Short stature is a potential concern with systemic corticosteroids when used long-term, but inhaled formulations at recommended doses carry much lower systemic absorption, making this a lesser concern and not the priority teaching point. Weight loss is not associated with inhaled corticosteroids; systemic steroids are more associated with weight gain. Peptic ulcer formation is a risk with oral or systemic corticosteroids, not with inhaled corticosteroids, because systemic absorption from the inhaled route is minimal. The most practical and common adverse effect requiring patient and family education for an inhaled corticosteroid is oral candidiasis.