As you say, Dr Mendelson is obviously not writing with regards to CAH in his work about fevers.

"I consulted one of my books written by Dr. Robert S. Mendelsohn, M.D. (one of America’s leading pediatricians) regarding fevers. This applies to children without CAH - CAH, of course, was not discussed in his book. He writes,"Unless your child’s fever is accompanied by additional symptoms, Additional symptoms are also inclusive of the medical condition that the child has that can comlicate matters with just ordinary illnesses that a healthy child can cope with.  The ball game is completely different because our kids are at adstinct disadvantage.  Therefore the rules all chance.  As  parent I hate to give any kind of meds to my kids without there being a good reason for it.  However, I think sometimes it is sensible to avoid certain complications--no matter how small or remote the chances---such as complications of convulsions, i.e. biting tongue or collapsing whilst your not there and hitting their head on something or taking a turn and injuring themselves.  Even doing this in the middle of the night when your fast asleep.  Who knows when a child’s temperature is going to take a sharp rise enough to cause a convulsion?  I thought the whole objective was to avoid that and eliminate the risks?  Especially with a CAH child when things can take a turn for the worse much much faster than an normal healthy child.  Let’s face it, if temps spike in the middle of the night, would any of us really know what was going on for a child if we were asleep.  My son has not been able to move he has been so sick at at times and he has not come to wake us up.  He has lay there ill and the situation escalates so much more quickly for these kids.  Bringing the temperature down is MOSTLY sensible for a CAH kid as for one, they are far less likely to handle a high temp.  Also the higher the temp, the more call for cortisol I would imagine so, leaving them to have a high temp and fit is in my opinion totally the wrong thing to do as they are simply not able to meet the demands without increase of their cortisol doses anyway.  So if you have a scenario where the parent is questioning whether or not to double AND denying the child the panadol to bring the temp down, this I feel is bound to lead to an adrenal crisis for sure.  The virus takes second place here--and keeping them stable adrenally is the correct protocol to follow.  We know a virus has to run it’s course, but it is very important to realise that a child can be helped through that with assistance of lowering the temp and cortisol levels or left at the mercy of the virus and possibly ending up having a 100mg shot at the worst of it and rushed to hospital.  I basically feel it is much kinder and a much faster recovery to avoid the adrenal crisis actually.  For ANY child with CAH.  as vomiting or respiratory difficulties, it need not be a cause of concern, even if it reaches 105. More important in determining whether a fever is the result of a mild infection like the common cold, This to me is silly.  Especially for a CAH child.  Mild cold may be ok in a normal healthy child, but they can make the extra cortisol to deal with the mild cold.  A child with adrenal insufficiency NEEDS to be given it orally.  The meds your children are scripted on a day to day basis are only enoigh to cover them in normal health.  Not for anything MORE than that.  Be it a mild cold or whatever.  That is why we are given the option to either double or triple and the option to extend that over one day, two days or three days or longer.  This is where a parent neds to judge.  Mild cold--ahh I double for one day and play by ear.  Ear infections and temp---ahh much more serious--I need to triple for a day and play by ear  and possibly drop down if the child is well, if not but temp is down then just double.  A normal child’s adrenals does all this for them, so their symptoms and their reactions to the illness may be more fitting with what Dr Mendelson describes or expects.  or a more serious one such as meningitis, is the overall appearance, behaviour, and attitude of you child." He also writes, "Untreated fevers cused by viral and bacterial infections do not rise inexorably and will not exceed 105 degrees." It still talks of the non-cah child here.  A fever in a non-cah child may climb higher because of the deficit in cortisol and an infections from a viral illness is possible which can complicate matters here also.  For example a cold and cough may develop to a chest infection which will affect the temp and everything else completely.  However, without doubling the cortisol and also not taking the temp down this can lead to much worse for a child with CAH.  I dread to think what would happen for a child with adrenal crisis and a temp so high they had a fit in the middle of it.