I have no idea why you would feel that dosing a child that wakes at 6am at 7am is unecessary really.  Did you actually read the link I provided to the page about cortisol starting to climb after 30 minutes of a person rising.  Given that I know you are well aware of the bio availability of Hydrocortisone and that it can take some time to start working, I would have thought that even you would have to agree that if the studies I posted are true (and they are official studies Carol) that it would make sense that a CAH child does not differ where circadian variation is concerned in any way, shape or form.  If they have done a long period without cortisol and they rise and you leave that morning dose to when they should have waken, you are creating more of a problem where 17 OHP levels are concerned.  These are facts not fiction.  

Had my son been waking at 6am, because I beleive this I would have dosed  him at 6am and consequently ALL of his doses thereafter would have been shifted to suit.  However, he does not wake at 6am, he wakes at 7am.  I guess that’s lucky for me isn’t it?  Means I don’t have to shift things around at all.  I think you also know and realise that just because I believe that waking up earlier equals a change in the "times" that he is dosed, it doesn NOT discount all I know where circadian variation is concerned.  If anything Carol, I think it would suggest that basically, I am prepared to think outside the square and move his regime to times that are better suited to his routine.  For example you dose Nick at 6am or did do the last time I contacted you.  Point is, does it change your thinking on circadian variation just because you dose an hour ealier.   I doubt it.  It suits your routine that’s all.  There is no difference in this where Hydrocortisone is concerned either.  

I’d rather be honest with people and tell them the truth where it concerns what their babies levels are probably doing first thing in the morning if they wake and don’t get their med’s until an hour after than have the child’s bloods affected to the detriment due to the deficit in cortisol for an hour.  Especially given that we now know that 30 minutes after getting up, their levels are "trying" to rise some 50%.  Are we now going to say that that 50% would be cortisol in a CAH kid or 17 OHP there? 

I don’t mind debating with folks about all this, but I posted facts in the midst of all this and above and that has got to count for something at the end of the day.  Unlike what a Doctor has said to a parent when he has obviously NOT read the study that I cut and pasted.  It is obvious that any Doctor reading that and having the opinion that your has would change their opinion.    Read the study I cut and pasted above in the other thread to Sue.   I just posted the facts as I found them and and don’t think anyone would do any different given what they were. 

Sue asked a question about whether it varied and I answered it.  That’s all. :)