Exactly Janet.

They feel that compliance comes before normality.  So therefore they don’t advise how it should be dosed because that would make a lot of parents feel they should switch.  They feel it better to get the dose down a child whilst an adult can remember (albeit however bad it is for the child to have a high dose at such a bad time--and it is bad where growth is concerned) to do it late at night, than have them forget the odd 3am dose.  However, how many of you have woken at around that time anyway and been to the loo?  If an alarm goes off at that time, because your more likely to be in the REM stages of sleep, it is heard and it doesn’t have to be a loud alarm either.  I have a G-Shock watch with five alarms on to remind me of the doses now and the 3am one set on it.  Thats enough for me to wake up to be honest. 

Besides, we think nothing of waking when they are babies to feed them?  So to me waking to give a vital med is just as important as a night time feed for a newborn.  They would never think to advise you to give em a big bottle at 10pm and ignore the next feed.  LOL!  

Anyway, that study there is 15 years old Risty.  Which kind of makes you wonder why they have not made tablets in this day and age that can be given at 10pm and be active more at the time they should be.  Even the Doctors that did the study on 2000 are more interested in drugs like the asthma inhalers (pred) at 10pm, which to my mind is even MORE anti-growth than hydrocortisone last thing at night.  I wrote to Dr Hindmarsh last year and we talked about that in email.  He has a few patients with Addisons that do the 3am dosing but he wanted to look into asthma inhalers (due to potency in them) to give to children with CAH.  I did write back my thoughts and aversions to that, but I don’t know what would come of it because I am just a parent.  I told him what we needed was a time release tablet if anything.  He seemed to have little faith in the manufacturers ever getting off their butts to make one.  I feel therefore that the studies are going to sit there for another 15 years before someone else looks into it.  :)  I’ll be damned if I’ll dose conventionally though just because they didn’t pull their finger out and use them for the purposes they should be used really.