Table 1 Typical multidisciplinary protocol for the CAH clinic at The Children's Hospital of Oklahoma.

1st Month

(i) Metabolic stability

(ii) Provide parents with an understanding of disease and treatment

(i) CAH panel every visit

(ii) Electrolytes every visit

(i) Meets with RN each visit re: medical regimen and stress dosing

Up to 3 years

(i) Establish optimal medical regimen

(ii) Feminizing surgery as needed for females

(i) CAH panel every visit

(ii) Electrolytes through 1st year

(iii) BA yearly starting at age 2

(i) Meets with RN each visit re: medical regimen

(ii) Meets with RN annually re: stress dosing, medic alert, and CAH quiz

Females see urologist at 3, 6, 12 months

3, 12, and 24 mo

3 y to adolescence

(i) Adjust medical regimen to maintain normal growth and health

(ii) Increase child's understanding of condition as appropriate for age

(i) CAH panel every visit

(ii) BA yearly until epiphyseal fusion

(i) Meets with RN each visit re: medical regimen

(ii) Meets with RN annually re: stress dosing, medic alert, and CAH quiz

Females see urologist prior to menarche

Annually or more often as needed

Adolescence

(i) Adjust medical regimen to maintain normal growth, pubertal development and maintain health

(ii) Increase child's understanding of condition as appropriate for age

(iii) Follow-up with Urology for females

(i) CAH panel every visit

(ii) Annual testicular exam for boys

(i) Meets with RN each visit re: medical regimen

(ii) Meets with RN annually re: stress dosing, medic alert, and CAH quiz

Females see urologist prior to becoming sexually active

Annually or more often as needed

Adulthood

(i) Transition to adult medical care

CAH panel every visit

As needed

Annually or more often as needed