We give our daughter who is eight, and has SWCAH her Cortef doses as follows:

5:30 am, 1:30 am and then 9:30 am. We give the 9:30 dose at 9 in the school year. Closer to her bedtime. 

Here is my advice. Like any, you can take it or leave it. But this is what we have done. My daughter will be entering the second grade this year. (she has a late birthday so we started kindergarten later) Please don’t feel bad for them taking their meds. during school. I mean yes, you can’t help it as a parent. But keep those feelings inside. My goal was always to make sure my daughter felt like any other kid. Now you are probably thinking, "and having them leave class for a pill is going to make them feel that way?" Yes. If the teacher has the same attittude as you do. At the begining of the year we talk with her teacher, find out what is a good time to send her down for her pill and plan on it. I let them give her that afternoon dose between 1 and 1:30. Usually there is a class change at these times so we have planned on it in between. If there is an assembly, I always make a note on my calander of the assembly, call the school nurse and let her know that this assembly will fall into her med. schedule and it is ok to give her her dose earlier. OR the school nurse will call me if it conflicts with an assembly if I missed the calander reminder. Empower your child in case the kids ask her to tell them why she takes it. We have had at least one kid a year ask. My daughter simply tells them, she takes her pill to make her feel good during the day. That was in preschool and kind. Then as she got older she tells them she takes the pill to give her body what her body cannot make.  Kids are pretty simple. Short explanations go a long way. I empower her to make that choice of what to tell them. I tell the teachers she is not to be caudled. She is to be treated like any other child except when she is ill or out in the heat. Again, as they get older empower them.  Talk to your child. Even if you think you had a talk with them last year about CAH, talk to them again this year, they are older. Keep that conversation open to questions because they learn more every year. They may have different questions. In my daughter’s school there are so many kids getting meds. during the day it is a thing that comes natural to the kids surrounding her. She has a diabetic in her class. I think if you convey the attitude to the teacher that you want, that teacher can convey that to the students. Personally I think giving the pill too late in the day isn’t a good idea but one, I am not the parent, two I am not the endo. and three what works for one may not work for another. I find my daughter lags at that time of the day if I miss a pill. I talked in depth with my daughter’s endo. about what time her afternoon meds should be given at school when she first started. He told me the earlier the better. It is the way the body uses cortisol naturally. Her body would need it more in the early afternoon than late afternoon. It made sense to me so we kept the 1-1:30 schedule. Like I said what works for one may not another but don’t hold off that dose so they won’t feel embarrassed. You are setting the attitude of her or his disease. They look to their parents for examples. If you have a good attitude about CAH they will too.