Hi Sandra,

Your son and Julia's daughter are on the same total dose, but the dosing times and amounts are very different.  It certainly could be that Jackson will do well on his current schedule.  You would have to use a pharmacy made suspension or have custom capsules made to do it much better than you are now.  I'll send you the graphs comparing the two schedules.  Julia has posted the information about the custom capsules.

Julia is interested in a dosing adjustment because her daughter is very tiny.  If Jackson is growing well (both height and weight), and his test results look good, you may be fine just as you are.  I do have one suggestion to easily improve your current schedule.  The 8:30am dose is coming too late to efficiently address the 8am cortisol peak.  I'd move it back to 6 to 7am, whenever you first get up in the morning.  I agree that the morning dose, given early, should be the largest.  If you look at the circadian rhythm graph, you'll see why.

I haven't seen Cortef bioavailability studies on infants.  It could be that the half-life and clearance rate are different than for children 2 and up.  There are several studies that warn against oversuppression in infancy, since it is believed to compromise final height.  I'd keep an eye on his height velocity, and make adjustments as necessary.

Again, there is no one right answer.  Using a dosing schedule similar to Moeller's 1985 study has resulted in significantly reduced Cortef doses for my girls, but that may not be the case for everyone.  The doctors don't agree, so how can we? 

LauraK