Hi Mike,

Wecome to the board.  Hope all is well with your little bundle. 

Just out of curiosity here a few questions:

 What dose of prednisone are we talking about?

How often do you have to give the dose?

When your child was diagnosed did they give him/her prednisone right from the start or was it hydrocortisone?

How often are your blood tests at the moment and are these coming back within the normal ranges? (What are the results?)

Primarily children with CAH are treated with Hydrocortisone but over the last decade there has been a move towards treatment with longer acting corticosteroids (used in different circumstances)  just as long as they are fine tuned and tailored to your child's needs you should be ok.  I'd say that if your Endo is treating with Prednisone in a baby that he/she is quite obviously pretty much onto things to be confident with that particular type of drug.  In the past that and dexamethasone were avoided in children because they were said to affect growth.  However, they were getting the potency of the drug (dex) all wrong (don't know about prednisone but they used to think that dex was only 30 times more potenet than HCT but now it is thought to be 80 times more potent) and children back then were grossly over suppressed for this reason of they used such.  I've read that prednisone is 5 times more potent than hydrocortisone (Paediapred syrup contains 1mg prednisolone per 1ml) So the daily dosing is generally 3mg to 6mg per square metre of body surface area every 24 hours.  Because it is a longer half life in the blood than hydrocortisone or cortisol , then half the daily recommended dose can be given twice daily over 24 hours.  For example 1.5mg to 3mg per square metre of body surface area, twice daily.  As hydrocortisone is excreted every 6 - 8 hourly it has to be dosed every 8 hours and sometimes more often.  Prednisolone seems to me to be an ideal solution for a baby as they don't like the taste and so the less you have to dose the better in my opinion.  Also, they seem to spit up heaps in the first few months after or during feeds and so dosing twice a day is probably better outside their feeding times.  They will tune your babies dose up and because you are using syrup, you can better titrate the dose to the babys needs right down to the last 0.5ml on a 5ml syringe.  It certainly makes better sense to me than dosing twice daily with HCT which in theory is every 12 hours and must sometimes cause problem with break through androgen if it is excreted in 6 - 8 hours theoretically speaking. Then again many believe that  it is not metabolised so fast in new borns and that twice a day HCT is ok.  Anyway, at the end of the day the same side effects apply if over or under dosed (no matter which is used) and if I were you I would not worry so much about the choice of corticosteroid they have scripted but rather learn how to interpret the blood results so that you as parents can know when there is a problem with over or under suppression.  There are many people on the message board who can answer any questions and help you to do this if you are stuck and need some help.  Take care and congratulations on the birth of your new child and then finding this message board too at such an early stage.  You can be sure that the outcome for your child is going to be good in using the board from such an early age!  Look forward to hearing your queries soon.

JH