If he misses the afternoon dose, my son feels generally ’unwell’.  He is tired, irritable, says he has a headache and feels sick!  I think maybe that Dr New does try to find the lowest possible hydrocortisone dose for a patient (in order to prevent unnecessary side-effects of over treatment) and although day to day this is better for the child, it does not allow for those ’off days’ when a little extra could be required for stress.  I do think thrice daily administration is better as it gives a  ’top up’ boost when a child maybe getting low on cortisol.