1. Meet with the school nurse (or person in charge of medication administration). Discuss CAH with the people who will be caring for your child on a daily basis. Try to convey the seriousness of the condition without too much drama. This approach might seem a bit overwhelming for some educators.

wording such as, "to be administered in times of injury, fever, and/or illness and/or at the parent's discretion" and should include a dosage limit, i.e. "up to X mgs".

3. Meet with your principal. Most principals want to be aware of any child at their school who might have unique needs or disorders. This is a good failsafe for an emergency situation if the nurse is unavailable. The principal is in charge of everything that happens at that school; attempting to explain CAH in an emergency to the person in charge results in wasted time.

4. Meet with your child's teacher(s). This is where your child will be spending his day. Meet with the teachers to give them a brief rundown of what CAH is and why your child might have special needs. Many parents have their CAH child carry a water bottle to prevent dehydration, but be prepared that a doctor's order might be required. Discuss falls on the playground and whether or not you would like to be called for any and all mishaps.

5. Try to schedule meds at times that are the least disruptive. Fitting in a trip to the nurse's office during a break (perhaps on the way in or out for recess) or in between classes is generally the best way to allow for a school day that is as normal as possible. If there are no breaks in between classes near the needed time, discuss with the teacher the best time to allow your child to leave the classroom.

One issue that might be a difficult one for some of you: Discuss with your doctor the Solu-Cortef issue and whether or not s/he considers it a necessity for school. While this may seem like an obvious necessity to you, remember that you are dealing with legal issues concerning an IM injection and you may find yourself in a struggle with the school system. Most of us carry the Solu-Cortef kit with us everywhere. However, to require the school to do so can get tricky. Consider field trips, for example. Depending on the rigidity of the school system you are in, many areas will require an RN to be available to give an injection. If this means hiring an RN to accompany your child on all field trips, many school systems will balk. Here's what the American Disabilities Act states: "Public entities are not required to take actions that would result in undue financial and administrative burdens. They are required to make reasonable modifications to policies, practices, and procedures where necessary to avoid discrimination, unless they can demonstrate that doing so would fundamentally alter the nature of the service, program, or activity being provided." (www.ada.gov ADA Title II: State and Local Government Activities). In other words, this is an issue that will vary greatly throughout the municipalities. This is also an area where those in private schools might be told that their child is too great a "risk" to have in their school. Again, carefully consider bringing up the Solu-Cortef issue. If you live or work close to the school, or if you have family or friends versed in IM injections and who can arrive at the school quickly in an emergency, maybe this is an area where you would want to maintain 100% control. Talk to your ped endo about the best course of action for your CAH child.

Many parents choose to leave information with the school nurse concerning CAH. Many parents have a letter written up by their doctor explaining what to do in an emergency, including information and instructions for EMT's, paramedics, or emergency room personnel. There have been varying degrees of success with this approach. CARES Foundation has a few sample letters that have been used. These samples are available on our website under Adrenal Crisis.

We all know that our CAH kids are among the brightest kids out there, and they certainly deserve the best we can give them. Sending them off to a new setting can be scary, but with good communication lines, they, too, can enjoy this "wonderful time of the year"!