When I was first taught how to give a jab by the district nurse six years ago she demonstrated where the best place is to give a jab if you have to do this.  The largest muscle is the buttock and this is why they recommend doing it there rather than in the arm or leg.  I think I remember one parent noting a few weeks ago on the message board that they hit the bone and caused a problem so that kind of illustrates the importance of getting this right and practising a great deal on a piece of fruit.   To inject into the buttock correctly she told me to imagine that the buttock is divided into quarters looking right way up.  The injection I believe must fall on the outer part of the top right quadrant or part of the buttock.  She told me that there are nerves that run down the centre of the buttock and the legs and that if you hit these you can damage them and cause paralysis in that particular side.  I  feel that it therefore is very important to learn not just how to do the jab but  where  to do the jab.  I was told to practise on fruit and use one syringe over and over and practise drawing the fluid up, (water for these purposes) holding it upright and squirting any air out.  To do this until it becomes second nature!  Also, she told me that in addition to nerve damage that if you inject direct into the vein instead of the muscle, that this can be very dangerous as it travels straight to the heart and can have fatal consequences.   I guess this all illustrates the need for practise and to be taught these techniques and told these dangers.  I wouldn't want to be frightening anyone away from the whole concept of doing this for your child, but imagine how parents would feel if they didn't know and caused damage such as this or something bad happened.  I was quite greatful that she pointed these facts out to me.  This like I say was six years ago and obviously Douglas is very knowledgeable as he knows this and knows the importance of all aspects of his childs treatment if he knows this much as far I I am concerned. 

Also as far as a missed dose is concerned Douglas---  WE HAVE ALL done this in caring for our kids.  It is not a crime and it is not going to be life threatening--unless they are really sick and cannot go without the nest dose---and we are none of us infallible.  A missed dose may cause excess androgen or breakthrough and this is not really good for boys or girls with cah, but it certainly isn't life threatening.  In an ideal world we would not be late or miss a dose but unfortunately to err is human--and I am almost sure that they should not be able to use such things in this way.  You need a good lawyer who is familiar with medical and matrimonial problems.  Don't give up because I'm quite sure that that little boy wouldn't want you to.  He needs both parents.

JH