Our bodies have a natural rhythm of when hormones are secreted.  Dosing according to this circadium rhythm is a way of trying to mimic what the body would do normally if it could.  On a graph of when cortisol is released it shows a large peak around 3am, another large peak around 7am , a medium size peak around noon and a smaller peak at 5pm.  So in trying to mimic this rhythm we give the largest dose at 3am, an almost as large dose at 7am, a medium size dose at noon and a small dose at 5pm. 

If your child is not having any side effects from the cortef you probably do not need to change anything.  We switched because my daughter stopped growing and was completely off the % charts when my hubby is 6’5" and I’m 5’8".  It just wasn’t right.  She has been on this 2 years and is now in the 65% height and weight!  Her bone age is right on as are her hormone levels.  The only problems have been buying clothes to keep up and having to increase her meds slightly more often to keep up with the growth.  Take care, Julia