At low-to-medium doses appropriate for childhood asthma, inhaled corticosteroids have an excellent long-term safety profile. The concern about growth suppression is real but quantitatively small — studies show a reduction in final adult height of approximately 1cm or less with low-dose ICS therapy — and this needs to be weighed against the documented harm to lung development from uncontrolled asthma. Oral thrush is prevented by rinsing the mouth after each dose. Systemic steroid effects — adrenal suppression, bone density reduction, cataract — do not occur at standard ICS doses for childhood asthma. At Pulmovista Clinics, I review all children on ICS annually to ensure they are on the minimum effective dose, stepping down when control allows.