These are all questions we ask at various times because I have said on many occasions that guidence on the environment our kids encounter outside the doctors office is beyond a joke.  Before parents find a board like this we invent the wheel every single time. 

There is nothing stopping our kids doing whatever physical activity all kids do.  Personally, I have not encourage Liam to ride a bike or scooter because his balance and coordination make it a certainty he will crack or break a bone.  I need to be certain I am around and this is not possible.  Luckily, we have always lived in areas where you have to be a masochist to get on a bike.

You do not need to give any extra hydrocortisone for short bursts of exercise or low impact exercise such as swimming.  Liam does 45 mins continuous swimming training and just wants a snack at the end of it.  When he has a swim meet however I will give an extra 2.5mg because the extra excitement will be a factor.  I always give Liam a snack before any exercise and if it is going to be a long stint will give him .5 glucose tablet.  If it is hot(85+) he will get a salt tablet and 2.5mg HC. 

The doctors always say that emotional stress is not a factor in CAH but we know(parents) it is.  We have learned that anything that is exciting and unexpected will need 2.5/5mg HC boost.  For us this means Christmas morning, birthday, visist to cousins etc. 

You will notice that all of the above doses are what work for Liam and we have never stress dosed him(2x/3x daily dose) for physical or emotional stress.  Our rule for emotional stress is to give 5mg if he is emotionally stressed for 30/45 minutes.  This has only happened twice in 9.5 years but we have told his teacher to have the nurse give 5mg if he is ever upset for this period of time.

Everything above are things we have figured out on our own and not the instructions of our doctors.  The extra doses do not happen very often and I do it on my gut feeling for Liam's condition at a particular point in time.  We know our kids and I have been lucky enough to be a father who has been at home.

The post I posted on page 3 explains glucoeneogenisis and HC's interaction in the body and gives the reasoning for good diet habits and in our cases regular snacks for our kids.

I have to run but I hope I have touched on some of your concerns.

ShaunP.