My son was taking 2 (.1mg) tablets of Florinef every day until he was 6 months old. Then we reduced it to 1 1/2 and finally to 1 (.1 mg) tablet. He has been on that dose for about a year and his sodium/potassium levels have been good. I heavily, heavily salt his food and give him lots of water. The "round, fat face" sounds like Cushings. This can happen from too much Cortef. It is such a hard balance to find. The articles from NIH (the US research hospital doing the clinical studies with new drugs) discuss increasing or adding Florinef and reducing the amount of hydrocortisone. But again, it is a tough balance because too much Florinef can cause high blood pressure(among other things). Sorry I am not of more help. I wish you had access to more frequent blood tests. You are doing a great job. You seem to know your child so well, and with time I am sure you will find the right balance. Take care!